Provider Demographics
NPI:1295023109
Name:HACKETT, ROBERT C (BA, LMP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:HACKETT
Suffix:
Gender:M
Credentials:BA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GRAVITY WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9425
Mailing Address - Country:US
Mailing Address - Phone:253-709-8971
Mailing Address - Fax:
Practice Address - Street 1:18209 SR 410 E STE 100
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-826-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHACKERC434RP225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist