Provider Demographics
NPI:1265556591
Name:HAMILTON, RICKEY L (LMT,MTI)
Entity type:Individual
Prefix:MR
First Name:RICKEY
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LMT,MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 COUNTY ROAD 183
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-7021
Mailing Address - Country:US
Mailing Address - Phone:254-968-4682
Mailing Address - Fax:
Practice Address - Street 1:2289 NORTHWEST LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1701
Practice Address - Country:US
Practice Address - Phone:254-967-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT039853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist