Shawn Rueze Hackley, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT14615 Issued in CA

Practice address

501 Cypress St
Fort Bragg, CA 95437-5429

Phone

(707) 961-6191

Fax

(707) 964-6213

NPI assigned

Oct 3, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545955200000",
    "number": "1295923233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31740 CEDAR ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373922",
            "telephone_number": "707-961-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 CYPRESS ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375429",
            "telephone_number": "707-961-6191",
            "fax_number": "707-964-6213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18661 Old Coast Hwy",
            "address_purpose": "LOCATION",
            "city": "Fort Bragg",
            "state": "CA",
            "postal_code": "954378260",
            "country_code": "US",
            "telephone_number": "707-961-6191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HACKLEY",
        "first_name": "SHAWN",
        "middle_name": "RUEZE",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-03",
        "last_updated": "2018-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION NPI",
            "identifier": "1235316993",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wade Joseph Gray, MD
• Joel Macgregor Green, M.A./MFT
• Guy Wayne Grenny, PH.D.
• Eric I Gutnick, MD
• Hackley Physical Therapy, Inc.
• Gretchen Hahn, LMFT
• Amelia Hanney, DDS
• Happy Rides Inc.
• Happy Rides LLC
• Crystal Marie Harris, LCSW

• Physical Therapist in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.