Healthcare Provider Details

I. General information

NPI: 1740671544
Provider Name (Legal Business Name): SCOTT CURRAN HACKER P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 02/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 MISSION BLVD STE 101
SAN DIEGO CA
92109-8076
US

IV. Provider business mailing address

10513 ZENOR LN UNIT 34
SAN DIEGO CA
92127-6810
US

V. Phone/Fax

Practice location:
  • Phone: 858-488-3597
  • Fax:
Mailing address:
  • Phone: 559-859-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: