Individual
JUNE MARIE HACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
111 DONA ANA DR, TAOS, NM 87571-4108
(575) 737-0715
(575) 737-0601
Mailing address
PO BOX 2948, TAOS, NM 87571-2948
(575) 737-0715
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3132
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT3132
PT LICENSE
NM
Enumeration date
01/08/2021
Last updated
01/08/2021
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