Provider Demographics
NPI:1598230047
Name:HAMMONS, RYLEE ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:ELIZABETH
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W BERRY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3354
Mailing Address - Country:US
Mailing Address - Phone:918-541-5754
Mailing Address - Fax:
Practice Address - Street 1:418 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1626
Practice Address - Country:US
Practice Address - Phone:417-451-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018033788225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant