Provider Demographics
NPI:1265501589
Name:HAMPTON, NICOLE R (PTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44011 KINGS ARMS SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4880
Mailing Address - Country:US
Mailing Address - Phone:703-433-2500
Mailing Address - Fax:703-433-2558
Practice Address - Street 1:21475 RIDGETOP CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6580
Practice Address - Country:US
Practice Address - Phone:703-433-2500
Practice Address - Fax:703-433-2558
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602054225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant