Provider Demographics
NPI:1346363348
Name:HAMILTON, JUSTIN WADE (PT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WADE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:2636 SUNSHINE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6303
Mailing Address - Country:US
Mailing Address - Phone:805-306-1555
Mailing Address - Fax:
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-2939
Practice Address - Fax:818-719-3045
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA248392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic