Provider Demographics
NPI:1114089059
Name:HAMBLOCK, MICHAEL H (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:HAMBLOCK
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 1:2901 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4109
Mailing Address - Country:US
Mailing Address - Phone:406-494-7050
Mailing Address - Fax:406-494-1424
Practice Address - Street 1:3718 E LAKE DR
Practice Address - Street 2:SUITE A
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4314
Practice Address - Country:US
Practice Address - Phone:406-494-7050
Practice Address - Fax:406-494-1424
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT374PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMSF1151174OtherSTATE FUND
MT0346112Medicaid