1245266436 NPI number — LAURI SWALLOW HAMMONTREE PT

Table of content: LAURI SWALLOW HAMMONTREE PT (NPI 1245266436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245266436 NPI number — LAURI SWALLOW HAMMONTREE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMONTREE
Provider First Name:
LAURI
Provider Middle Name:
SWALLOW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWALLOW
Provider Other First Name:
LAURI
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245266436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1908 FLINT RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35601-6031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-340-9708
Provider Business Mailing Address Fax Number:
256-340-9624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11186 AL HIGHWAY 157
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOULTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35650-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-905-7295
Provider Business Practice Location Address Fax Number:
256-905-7291
Provider Enumeration Date:
06/23/2006

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:  PTH4521 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 529917620 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003819608 . This is a "FROUP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".