Jennifer Jo Hackman, P.T. ,A.T.C.
Individual provider Active NPI Physical Therapist · Boonville, MO
NPI 1891790291 · NPPES record last updated Oct 17, 2007
Key facts
- NPI
- 1891790291
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2002024893 (MO)
- Practice address
- 1420 W Ashley Rd
Boonville, MO 65233-2112 - Phone
- (660) 882-6115
- Fax
- (660) 882-6120
- NPI assigned
- Jun 14, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002024893 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BDM Associates LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2002024893 | MO | Yes |
Addresses
Primary practice location
1420 W Ashley Rd
Boonville, MO 65233-2112
Mailing address
1420 W Ashley Rd
Boonville, MO 65233-2112
Phone (660) 882-6115
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122566 | Other | BLUE CROSS BLUE SHIELD |
Other providers in Boonville, MO
- Lyndi Geha
- Elyssa Ann Gibbons
- Sammy H Goedrich
- Tanner Wayne Green
- Yvonne Guest
- Laura S Haines
- Dennis M Handley
- Hearing Aid Specialists Inc
- Andrea Theresa Hoehn
- Holtwick Chiropractic, P.C.
All providers in Boonville, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.