Provider Demographics
NPI:1063642072
Name:HAMMONS, JOHN S (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:HAMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-0134
Mailing Address - Country:US
Mailing Address - Phone:606-354-3403
Mailing Address - Fax:
Practice Address - Street 1:383 CORBIN CENTER DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1895
Practice Address - Country:US
Practice Address - Phone:606-526-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4007OtherSTATE LICENSE NUMBER