Individual
FELICIA DIANE HACKEROTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
16485 SW PACIFIC HWY, TIGARD, OR 97224-3446
(503) 620-5141
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
(888) 757-4571
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09217
OR
Other
Enumeration date
07/23/2015
Last updated
07/23/2015
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