Provider Demographics
NPI:1457332009
Name:HAMMONS, MARK A (LPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:HAMMONS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4522
Mailing Address - Country:US
Mailing Address - Phone:270-442-4396
Mailing Address - Fax:270-442-3346
Practice Address - Street 1:220 BERGER RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4522
Practice Address - Country:US
Practice Address - Phone:270-442-4396
Practice Address - Fax:270-442-3346
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT001462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048013OtherANTHEM
KY0044942003OtherCIGNA
KY000000048013OtherANTHEM
KY0044942003OtherCIGNA
KYR40142Medicare UPIN
KY0657706Medicare PIN
KY5004902Medicare PIN