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NPI 1992229512

NPI 1992229512 : ALISON PAIGE HACKER PT : SHINNSTON, WV

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General NPI Number Information
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    NPI Number           |    1992229512
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    Entity Type          |    Individual 
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    Provider Name        |    ALISON PAIGE HACKER PT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/26/2017
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    Last Update Date     |    07/26/2017
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Provider Practice Location Address
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    Address Line         |    33 WALNUT ST 
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    City                 |    SHINNSTON
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    State                |    WV
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    Zip                  |    26431-1154
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    Country              |    US
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    Telephone            |    304-592-5041
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    719 FAIRMONT AVE STE 102 
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    City                 |    FAIRMONT
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    State                |    WV
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    Zip                  |    26554-5118
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    Country              |    US
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    Telephone            |    
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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       |    003832
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    License Number State |    WV
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