MEDICARE: MR. ROBERT C HACKETT BA, LMP

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	225700000X	Massage Therapist	HACKERC434RP	WA

General Provider Information

NPI Number	:	1295023109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT C HACKETT BA, LMP

Provider Business Mailing Address
First Line	:	730 GRAVITY WAY
Second Line	:
City	:	BUCKLEY
State	:	WA
Zip	:	98321-9425
Country	:	US
Telephone Number	:	253-709-8971
Fax Number	:

Provider Business Practice Location Address
First Line	:	18209 SR 410 E STE 100
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-826-5500
Fax Number	:

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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