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General NPI Number Information
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NPI Number | 1417203118
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Entity Type | Individual
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Provider Name | ERIC MICHEAL HACKENSON DPT
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Gender | Male
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 44 RIVULET ST
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City | UXBRIDGE
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State | MA
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Zip | 01569-3134
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Country | US
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Telephone | 508-278-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 134 POINT BREEZE RD
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City | WEBSTER
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State | MA
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Zip | 01570-3633
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Country | US
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Telephone | 508-847-2221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20076
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License Number State | MA
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