Individual
MR. CLINT WES HACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1149186
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171677100
FIRSTCARE
TX
05
—
219905101
—
TX
05
—
219905102
—
TX
01
—
8T3268
BLUE CROSS BLUE SHIELD
TX
01
—
P00451766
MEDICARE RAILROAD
TX
Enumeration date
06/13/2005
Last updated
11/15/2012
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