Provider Demographics
NPI:1164831061
Name:HAMILTON, FATIMA ALICIA
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:ALICIA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1638
Mailing Address - Country:US
Mailing Address - Phone:929-368-2422
Mailing Address - Fax:
Practice Address - Street 1:2401 RESEARCH BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-657-5650
Practice Address - Fax:301-657-5651
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008954225200000X
MDA4010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant