Individual
DREW THOMAS HACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
3365 S 103RD ST, MILWAUKEE, WI 53227-4161
(414) 604-7512
(414) 604-7509
Mailing address
PO BOX 1997, MILWAUKEE, WI 53201-1997
(414) 604-7512
(414) 604-7509
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
919-39
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
—
01
—
919-39
STATE LICENSE
WI
Enumeration date
12/31/2014
Last updated
12/31/2014
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