Provider Demographics
NPI:1417364837
Name:HAMPTON, NELDA RENEE
Entity Type:Individual
Prefix:MS
First Name:NELDA
Middle Name:RENEE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NELDA
Other - Middle Name:RENEE
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:318 WYNDHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326
Mailing Address - Country:US
Mailing Address - Phone:347-528-4316
Mailing Address - Fax:
Practice Address - Street 1:318 WYNDHAM DR
Practice Address - Street 2:PRIVATE HOUSE
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326-7450
Practice Address - Country:US
Practice Address - Phone:347-528-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004390-1225200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant