Basic Information
| Provider Information | |||||||||
| NPI: | 1558578500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAKKILA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 362 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032164994 | ||||||||
| FaxNumber: | 5032164071 | ||||||||
| Practice Location | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 362 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032164994 | ||||||||
| FaxNumber: | 5032164071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 12/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3631 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.