Provider Demographics
NPI:1427932110
Name:HACKATHORN, MARISA ANGELINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ANGELINA
Last Name:HACKATHORN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 MORNING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3350
Mailing Address - Country:US
Mailing Address - Phone:330-524-5832
Mailing Address - Fax:
Practice Address - Street 1:16776 BERNARDO CENTER DR STE 204A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2559
Practice Address - Country:US
Practice Address - Phone:858-361-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH294958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist