MEDICARE: MRS. ANDREA MAUPIN HACKER RPT

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	0409	NH

General Provider Information

NPI Number	:	1164547279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MAUPIN HACKER RPT

Provider Business Mailing Address
First Line	:	239 DEPOT ROAD
Second Line	:
City	:	HOLLIS
State	:	NH
Zip	:	03049
Country	:	US
Telephone Number	:	603-465-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 PROSPECT STREET
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03061-2014
Country	:	US
Telephone Number	:	603-577-2887
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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