Provider Demographics
NPI:1346376449
Name:HACKMANN, AMY J (RPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:HACKMANN
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 1:13615 REDFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:MO
Mailing Address - Zip Code:65032-2174
Mailing Address - Country:US
Mailing Address - Phone:573-498-3474
Mailing Address - Fax:
Practice Address - Street 1:801 S 8TH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2724
Practice Address - Country:US
Practice Address - Phone:913-637-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003022496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist