Provider Demographics
NPI:1053471193
Name:HAMRIC, MITCHELL C (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:C
Last Name:HAMRIC
Suffix:
Gender:M
Credentials:PT, MS
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Mailing Address - Street 1:8097 MADISON BLVD
Mailing Address - Street 2:#102
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2044
Mailing Address - Country:US
Mailing Address - Phone:256-461-7173
Mailing Address - Fax:256-461-7175
Practice Address - Street 1:8097 MADISON BLVD
Practice Address - Street 2:#102
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2044
Practice Address - Country:US
Practice Address - Phone:256-461-7173
Practice Address - Fax:256-461-7175
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51520412OtherBLUE CROSS-ACTIVE P.T.
AL51072058OtherBLUE CROSS-COMPLETE P.T.
AL51520412OtherBLUE CROSS-ACTIVE P.T.
AL51072058OtherBLUE CROSS-COMPLETE P.T.
ALS17328Medicare UPIN