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NPI Code Detail

MEDICARE: MRS. JENNIFER JO HACKMAN P.T. ,A.T.C.

MEDICARE:  MRS. JENNIFER JO HACKMAN  P.T.   ,A.T.C.
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
1225100000XPhysical Therapist2002024893MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1122566OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1891790291
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER JO HACKMAN P.T. ,A.T.C.
Provider Business Mailing Address
First Line : 1420 W ASHLEY RD
Second Line :
City : BOONVILLE
State : MO
Zip : 65233-2112
Country : US
Telephone Number : 660-882-6115
Fax Number : 660-882-6120
Provider Business Practice Location Address
First Line : 1420 W ASHLEY RD
Second Line :
City : BOONVILLE
State : MO
Zip : 65233-2112
Country : US
Telephone Number : 660-882-6115
Fax Number : 660-882-6120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 10/17/2007

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