Provider Demographics
NPI:1538939517
Name:ACKERMAN-MILLIKAN, MAEGAN CLARAY (DPT)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:CLARAY
Last Name:ACKERMAN-MILLIKAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412031
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2031
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:13329 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-9496
Practice Address - Country:US
Practice Address - Phone:269-649-2400
Practice Address - Fax:269-649-0548
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MI5501303029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist