Provider Demographics
NPI:1518975028
Name:HUMMEL, WILLIAM J (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EAGLES NEST PARK
Mailing Address - Street 2:SUITE E
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2766
Mailing Address - Country:US
Mailing Address - Phone:864-882-7965
Mailing Address - Fax:864-882-7967
Practice Address - Street 1:135 EAGLES NEST PARK
Practice Address - Street 2:SUITE E
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-7965
Practice Address - Fax:864-882-7967
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0182Medicaid
SC1933Medicare PIN
SCQ31241Medicare UPIN