Provider Demographics
NPI:1770561169
Name:HAMMERQUIST, RICK C (MPT OCS)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:C
Last Name:HAMMERQUIST
Suffix:
Gender:M
Credentials:MPT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 STATE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4132 DEVONSHIRE CT NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1982
Practice Address - Country:US
Practice Address - Phone:503-364-5313
Practice Address - Fax:503-364-5296
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR138972Medicare PIN