Provider Demographics
NPI:1235620980
Name:HAMM, TAYLOR MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHAEL
Last Name:HAMM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S FLORIDA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1150
Mailing Address - Country:US
Mailing Address - Phone:863-647-3665
Mailing Address - Fax:
Practice Address - Street 1:3900 S FLORIDA AVE STE 107
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1150
Practice Address - Country:US
Practice Address - Phone:863-647-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist