Provider Demographics
NPI:1417253808
Name:HAMMOND, WOODROW WILSON III (MPT)
Entity Type:Individual
Prefix:MR
First Name:WOODROW
Middle Name:WILSON
Last Name:HAMMOND
Suffix:III
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WOODWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4217
Mailing Address - Country:US
Mailing Address - Phone:915-861-4647
Mailing Address - Fax:
Practice Address - Street 1:626 WOODWORTH ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4217
Practice Address - Country:US
Practice Address - Phone:915-861-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist