Provider Demographics
NPI:1164547279
Name:HACKER, ANDREA MAUPIN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MAUPIN
Last Name:HACKER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 DEPOT ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049
Mailing Address - Country:US
Mailing Address - Phone:603-465-7690
Mailing Address - Fax:
Practice Address - Street 1:8 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03061-2014
Practice Address - Country:US
Practice Address - Phone:603-577-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist