Provider Demographics
NPI:1508949306
Name:HACKER, JACQUELYN ELAINE (MPT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ELAINE
Last Name:HACKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 66TH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4828
Mailing Address - Country:US
Mailing Address - Phone:806-793-3900
Mailing Address - Fax:806-793-3937
Practice Address - Street 1:4601 66TH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4828
Practice Address - Country:US
Practice Address - Phone:806-793-3900
Practice Address - Fax:806-793-3937
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11678232251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics