Provider Demographics
NPI:1609387760
Name:HAKK, AMBER (PTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HAKK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:KETTELRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:11 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GWINNER
Mailing Address - State:ND
Mailing Address - Zip Code:58040-4001
Mailing Address - Country:US
Mailing Address - Phone:701-678-2244
Mailing Address - Fax:
Practice Address - Street 1:520 MAIN ST.
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:MN
Practice Address - Zip Code:56549
Practice Address - Country:US
Practice Address - Phone:218-483-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist