Provider Demographics
NPI:1609107614
Name:THE HAMMONDS CENTRE FOR ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:THE HAMMONDS CENTRE FOR ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:478-461-4946
Mailing Address - Street 1:4523 FORSYTH RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4527
Mailing Address - Country:US
Mailing Address - Phone:478-955-7443
Mailing Address - Fax:
Practice Address - Street 1:4523 FORSYTH RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4527
Practice Address - Country:US
Practice Address - Phone:478-955-7443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty