Provider Demographics
NPI:1851004436
Name:HACKLER, BROOKE (PTA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HACKLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 CRESTMORE PL
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3407
Mailing Address - Country:US
Mailing Address - Phone:608-220-1246
Mailing Address - Fax:
Practice Address - Street 1:3855 PRECISION DR STE 120
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9068
Practice Address - Country:US
Practice Address - Phone:970-667-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant