Provider Demographics
NPI:1639395080
Name:HAMMAN, CECILIA AUNDRA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:AUNDRA
Last Name:HAMMAN
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 1:513 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1407
Mailing Address - Country:US
Mailing Address - Phone:731-627-3931
Mailing Address - Fax:
Practice Address - Street 1:1900 PARR AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2009
Practice Address - Country:US
Practice Address - Phone:731-286-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant