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General NPI Number Information
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NPI Number | 1750106241
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Entity Type | Individual
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Provider Name | JERRY JOSEPH HACKER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 30837 E THOUSAND OAKS BLVD
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4039
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Country | US
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Telephone | 309-373-2287
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Fax |
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Provider Business Mailing Address
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Address Line | 14330 ALBERS ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-5104
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Country | US
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Telephone | 309-373-2287
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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 | 307278
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License Number State | CA
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