Individual
DYLAN ROGER HACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1715 BLANDING ST, COLUMBIA, SC 29201-3441
(803) 799-3926
Mailing address
1715 BLANDING ST, COLUMBIA, SC 29201-3441
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4673
SC
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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