Provider Demographics
NPI:1114455177
Name:HAMBURG, PEYTON MACARTHUR
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:MACARTHUR
Last Name:HAMBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 47TH CT STE F
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-2686
Mailing Address - Country:US
Mailing Address - Phone:601-917-5440
Mailing Address - Fax:
Practice Address - Street 1:2447 47TH CT STE F
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2686
Practice Address - Country:US
Practice Address - Phone:601-917-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist