Provider Demographics
NPI:1629798053
Name:HUMMEL, CAMERON JAMES (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:JAMES
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 LEGACY OAKS DR # 2102
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6556
Mailing Address - Country:US
Mailing Address - Phone:919-373-1799
Mailing Address - Fax:
Practice Address - Street 1:162 LEGACY OAKS DR # 2102
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6556
Practice Address - Country:US
Practice Address - Phone:919-373-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-43862255A2300X
NCP21541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer