MEDICARE: JOHN EDISON HACKETT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9332	TN

General Provider Information

NPI Number	:	1093063190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN EDISON HACKETT PT

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DR STE 600
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7286
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	2197 MADISON ST
Second Line	:	SUITE 106
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-5284
Country	:	US
Telephone Number	:	931-503-1700
Fax Number	:	931-503-1798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	11/13/2017

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