Provider Demographics
NPI:1750871331
Name:HACKMAN, MITCHELL MARKLAND (PT, DPT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:MARKLAND
Last Name:HACKMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7381 W 133RD ST
Mailing Address - Street 2:STE 302
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4772
Mailing Address - Country:US
Mailing Address - Phone:913-904-1128
Mailing Address - Fax:
Practice Address - Street 1:9760 N ASH AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-9742
Practice Address - Country:US
Practice Address - Phone:816-792-0803
Practice Address - Fax:816-407-9400
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05853225100000X
MO2018024531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist