Provider Demographics
NPI:1538313606
Name:HAMMOND, VICKI RENEE (ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:RENEE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 MICHELSON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1755
Mailing Address - Country:US
Mailing Address - Phone:562-925-8685
Mailing Address - Fax:
Practice Address - Street 1:300 S HARBOR BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3733
Practice Address - Country:US
Practice Address - Phone:800-561-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT-6149225200000X
CA0296025792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer