Individual
MR. CLINT WES HACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6202 82ND ST, LUBBOCK, TX 79424-3691
(806) 687-8008
(806) 687-8009
Mailing address
2431 S LOOP 289, LUBBOCK, TX 79423-1519
(806) 771-8008
(806) 771-8009
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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