Provider Demographics
NPI:1548646193
Name:ACKLES, KERESSA (ATC)
Entity type:Individual
Prefix:
First Name:KERESSA
Middle Name:
Last Name:ACKLES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 MEMORIAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8652
Mailing Address - Country:US
Mailing Address - Phone:832-247-6537
Mailing Address - Fax:
Practice Address - Street 1:1501 STATE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3306
Practice Address - Country:US
Practice Address - Phone:507-537-7165
Practice Address - Fax:507-537-7218
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer