Provider Demographics
NPI:1235316993
Name:HACKLEY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HACKLEY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE-HACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-961-1606
Mailing Address - Street 1:31740 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3922
Mailing Address - Country:US
Mailing Address - Phone:707-961-6191
Mailing Address - Fax:707-964-6213
Practice Address - Street 1:501 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5429
Practice Address - Country:US
Practice Address - Phone:707-961-6191
Practice Address - Fax:707-964-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14615261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy