Provider Demographics
NPI:1225152630
Name:HAMMER GOLF PERFORMANCE AND FITNESS
Entity Type:Organization
Organization Name:HAMMER GOLF PERFORMANCE AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:EGNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-558-9518
Mailing Address - Street 1:891 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0614
Mailing Address - Country:US
Mailing Address - Phone:408-558-9518
Mailing Address - Fax:408-558-9528
Practice Address - Street 1:891 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0614
Practice Address - Country:US
Practice Address - Phone:408-558-9518
Practice Address - Fax:408-558-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19820261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17070OtherPHYSICAL THERAPY LICENSE
CA19820OtherPHYSICAL THERAPY LICENSE