Provider Demographics
NPI:1457910416
Name:HACKETT, GEORGE (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HACKETT
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:GEORDIE
Other - Middle Name:
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3300 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1097
Mailing Address - Country:US
Mailing Address - Phone:602-639-6038
Mailing Address - Fax:602-589-2305
Practice Address - Street 1:3300 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1097
Practice Address - Country:US
Practice Address - Phone:602-639-6038
Practice Address - Fax:602-589-2305
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0003482081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine