Provider Demographics
NPI:1164116984
Name:HACKEROTT, ALEXANDER (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:HACKEROTT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3228
Mailing Address - Country:US
Mailing Address - Phone:918-407-8008
Mailing Address - Fax:
Practice Address - Street 1:9540 N GARNETT RD STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4410
Practice Address - Country:US
Practice Address - Phone:918-609-1300
Practice Address - Fax:918-609-1318
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist