Provider Demographics
NPI:1417114778
Name:HACKERMAN, MITCHELL A (PT)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:A
Last Name:HACKERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 TOWNBANK ROAD; SUITE 203
Mailing Address - Street 2:PROFESSIONAL PHYSICAL THERAPY & REHABILITATION, P.C.
Mailing Address - City:N. CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204
Mailing Address - Country:US
Mailing Address - Phone:609-884-9800
Mailing Address - Fax:
Practice Address - Street 1:650 TOWNBANK ROAD; SUITE 203
Practice Address - Street 2:PROFESSIONAL PHYSICAL THERAPY & REHABILITATION, P.C.
Practice Address - City:N. CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204
Practice Address - Country:US
Practice Address - Phone:609-884-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00526900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1295876795OtherGROUP NPI
NJ1295876795OtherGROUP NPI