Provider Demographics
NPI:1598317281
Name:HAMILTON, SHANDRA NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:NICOLE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20000 VICTOR PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7027
Mailing Address - Country:US
Mailing Address - Phone:734-953-1745
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:15500 19 MILE RD STE 330
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6313
Practice Address - Country:US
Practice Address - Phone:586-412-0016
Practice Address - Fax:586-412-0117
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist