Provider Demographics
NPI:1467650556
Name:HACK, LAURITA M (DPT)
Entity Type:Individual
Prefix:DR
First Name:LAURITA
Middle Name:M
Last Name:HACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GATCOMBE LN
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3629
Mailing Address - Country:US
Mailing Address - Phone:215-808-3787
Mailing Address - Fax:
Practice Address - Street 1:415 GATCOMBE LN
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3629
Practice Address - Country:US
Practice Address - Phone:215-808-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2530L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist