1659520203 NPI number — DR. MATT HUGHES HAMMERLE PT, DPT

Table of content: DR. MATT HUGHES HAMMERLE PT, DPT (NPI 1659520203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659520203 NPI number — DR. MATT HUGHES HAMMERLE PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMERLE
Provider First Name:
MATT
Provider Middle Name:
HUGHES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659520203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 LAKEPARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEHILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78063-6211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-316-5486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3851 ROGER BROOKE DR
Provider Second Line Business Practice Location Address:
MCHE QD (CREDS)
Provider Business Practice Location Address City Name:
FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-8693
Provider Business Practice Location Address Fax Number:
210-916-6679
Provider Enumeration Date:
09/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1086460 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)