Provider Demographics
NPI:1215397583
Name:HAMM, JOHN III (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HAMM
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 S NC HIGHWAY 119
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9565
Mailing Address - Country:US
Mailing Address - Phone:336-578-5815
Mailing Address - Fax:336-578-7269
Practice Address - Street 1:2502 S NC HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9565
Practice Address - Country:US
Practice Address - Phone:336-578-5815
Practice Address - Fax:336-578-7269
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5860225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant