Provider Demographics
NPI:1518321637
Name:HACKETT, KENDRA (LCMT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEAVEY ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1125
Mailing Address - Country:US
Mailing Address - Phone:603-758-6424
Mailing Address - Fax:
Practice Address - Street 1:2 SEAVEY ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1125
Practice Address - Country:US
Practice Address - Phone:603-758-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1719M172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist