Provider Demographics
NPI:1043360571
Name:HACKBART, KIMBERLY KATHLEEN (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KATHLEEN
Last Name:HACKBART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 CRESTCOVE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3295
Mailing Address - Country:US
Mailing Address - Phone:469-583-2521
Mailing Address - Fax:
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-768-9230
Practice Address - Fax:972-722-4087
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist