Provider Demographics
NPI:1881935534
Name:HAMMIT, LISSA J (BS ATC LMT)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:J
Last Name:HAMMIT
Suffix:
Gender:F
Credentials:BS ATC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 6TH ST NW
Mailing Address - Street 2:#9
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2033
Mailing Address - Country:US
Mailing Address - Phone:505-269-3273
Mailing Address - Fax:
Practice Address - Street 1:925 6TH ST NW
Practice Address - Street 2:#9
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2033
Practice Address - Country:US
Practice Address - Phone:505-269-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist