Provider Demographics
NPI:1235797028
Name:HAMMACK, BAILEY NICHOLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:NICHOLE
Last Name:HAMMACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:NICOLE
Other - Last Name:VRAZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15811 BAYOU OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:77534-6401
Mailing Address - Country:US
Mailing Address - Phone:979-265-2755
Mailing Address - Fax:979-859-7181
Practice Address - Street 1:115 W MYRTLE STREET
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-7751
Practice Address - Country:US
Practice Address - Phone:979-429-3288
Practice Address - Fax:979-859-7181
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist