Provider Demographics
NPI:1144259342
Name:HACKETT, ERNEST G (DC, RPT)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:G
Last Name:HACKETT
Suffix:
Gender:M
Credentials:DC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MILITARY TRAIL
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4628
Mailing Address - Country:US
Mailing Address - Phone:561-756-7870
Mailing Address - Fax:561-743-1192
Practice Address - Street 1:4600 MILITARY TRAIL
Practice Address - Street 2:SUITE 108
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4628
Practice Address - Country:US
Practice Address - Phone:561-776-2285
Practice Address - Fax:561-776-2856
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008906111N00000X
FLPT20931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY067MOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLY929FOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLY067MOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLY067MXMedicare PIN