Provider Demographics
NPI:1417128307
Name:HAMISAK, NANCY C
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:HAMISAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ALHAMBRA WAY S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4625
Mailing Address - Country:US
Mailing Address - Phone:727-526-9655
Mailing Address - Fax:
Practice Address - Street 1:1501 ALHAMBRA WAY S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-4625
Practice Address - Country:US
Practice Address - Phone:727-526-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 1244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist