Provider Demographics
NPI:1922439520
Name:HAMILTON, HOLLIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:HOLLIE
Middle Name:
Last Name:HAMILTON
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 1:156 WADDELL STREET
Mailing Address - Street 2:
Mailing Address - City:FAIR BLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28439
Mailing Address - Country:US
Mailing Address - Phone:910-770-1278
Mailing Address - Fax:
Practice Address - Street 1:718 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2561
Practice Address - Country:US
Practice Address - Phone:843-673-2694
Practice Address - Fax:843-673-2846
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant