Provider Demographics
NPI:1134265242
Name:HAMULA, BRENT JOSEPH (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:JOSEPH
Last Name:HAMULA
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 KENRICK ST APT 11
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3837
Mailing Address - Country:US
Mailing Address - Phone:617-519-1885
Mailing Address - Fax:
Practice Address - Street 1:144 KENRICK ST APT 11
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3837
Practice Address - Country:US
Practice Address - Phone:617-519-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12252255A2300X
NY0003472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer