Individual
TINA M HACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1400 49TH AVE NE, COLUMBIA HEIGHTS, MN 55421-1939
(612) 839-0249
Mailing address
10907 KENTUCKY AVE N, CHAMPLIN, MN 55316-3823
(612) 839-0249
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1731
MN
Other
Enumeration date
12/22/2006
Last updated
02/10/2016
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