Provider Demographics
NPI:1760015366
Name:HAMPTON, SETH (DPT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 N PENN STATION LN APT 202
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9426
Mailing Address - Country:US
Mailing Address - Phone:252-722-4758
Mailing Address - Fax:
Practice Address - Street 1:4424 E FLAMINGO AVE STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9291
Practice Address - Country:US
Practice Address - Phone:208-205-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist