MEDICARE: ALYSSA HAMM DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1831721000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA HAMM DPT

Provider Business Mailing Address
First Line	:	1500 GRAND CENTRAL AVE STE 101
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-1079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 CARROLL ST
Second Line	:
City	:	NEW LEXINGTON
State	:	OH
Zip	:	43764-9415
Country	:	US
Telephone Number	:	740-343-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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