1023057064 NPI number — HAMILTON PHYSICAL THERAPY PC

Table of content: (NPI 1023057064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023057064 NPI number — HAMILTON PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON PHYSICAL THERAPY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PT SPECIALIST OF FLORENCE
Provider Other Organization Name Type Code:
3
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:
1023057064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
336 FAIRGROUNDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59840-3126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-375-0980
Provider Business Mailing Address Fax Number:
406-375-9938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59840-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-375-0980
Provider Business Practice Location Address Fax Number:
406-375-9938
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-375-0980

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CH1515 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 184903000 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000080772 . This is a "MEDICARE B PIN" identifier . This identifiers is of the category "OTHER".




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