Provider Demographics
NPI:1083996086
Name:HAMILTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HAMILTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-538-7971
Mailing Address - Street 1:739 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1020
Mailing Address - Country:US
Mailing Address - Phone:304-538-7971
Mailing Address - Fax:304-538-6303
Practice Address - Street 1:739 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1020
Practice Address - Country:US
Practice Address - Phone:304-538-7971
Practice Address - Fax:304-538-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV650023946OtherRAILROAD MEDICARE
WV0157850000Medicaid
WV650023946OtherRAILROAD MEDICARE