Provider Demographics
NPI:1689386229
Name:HAMRICK, MINDY ANN
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ANN
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FERDINAND DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1596
Mailing Address - Country:US
Mailing Address - Phone:865-235-5267
Mailing Address - Fax:
Practice Address - Street 1:555 E BLEDSOE ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3003
Practice Address - Country:US
Practice Address - Phone:615-452-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004878225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPTA0000004878Medicaid