Individual
JERROD ACKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
390 E PARKCENTER BLVD, STE. 130, BOISE, ID 83706-6662
(208) 433-9211
(208) 433-9241
Mailing address
16083 SW UPPER BOONES FERRY RD, STE. 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3702
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0327602
WA L&I
ID
01
—
0327604
WA L&I
ID
01
—
0327610
WA L&I
ID
01
—
0327611
WA L&I
ID
01
—
0330328
WA L&I
ID
05
—
1487067005
—
ID
Enumeration date
06/11/2014
Last updated
12/15/2014
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