Provider Demographics
NPI:1053651679
Name:HAMMELL, NANCY KIM (DPT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KIM
Last Name:HAMMELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:207 VAN VORST ST APT 1403
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6351
Mailing Address - Country:US
Mailing Address - Phone:732-423-5375
Mailing Address - Fax:
Practice Address - Street 1:207 VAN VORST ST APT 1403
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-6351
Practice Address - Country:US
Practice Address - Phone:732-423-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01482700225100000X
NY035719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist