Provider Demographics
NPI:1417203118
Name:HACKENSON, ERIC MICHEAL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHEAL
Last Name:HACKENSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 POINT BREEZE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-3633
Mailing Address - Country:US
Mailing Address - Phone:508-847-2221
Mailing Address - Fax:
Practice Address - Street 1:44 RIVULET ST
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569-3134
Practice Address - Country:US
Practice Address - Phone:508-278-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist