Provider Demographics
NPI:1245289461
Name:HACKETT, ALYSON M (PT)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:M
Last Name:HACKETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2953
Mailing Address - Country:US
Mailing Address - Phone:315-579-2028
Mailing Address - Fax:
Practice Address - Street 1:125 BROOKLEY RD
Practice Address - Street 2:DONALD J. MITCHELL VA CLINIC
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4301
Practice Address - Country:US
Practice Address - Phone:315-334-7120
Practice Address - Fax:315-334-7137
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027580-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist