Provider Demographics
NPI:1750358578
Name:HAMON, TRACY (PT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:HAMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 W WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1391
Mailing Address - Country:US
Mailing Address - Phone:618-327-9216
Mailing Address - Fax:
Practice Address - Street 1:602 S 42ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6264
Practice Address - Country:US
Practice Address - Phone:618-242-1100
Practice Address - Fax:618-244-5148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist