MEDICARE: LANCE A HAMMONS PT, ATC

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	2255A2300X	Athletic Trainer	096-001848	IL
2	225100000X	Physical Therapist	070-013772	IL

General Provider Information

NPI Number	:	1952364978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE A HAMMONS PT, ATC

Provider Business Mailing Address
First Line	:	600 OAKMONT LN
Second Line	:	STE 600C
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 N RANDALL RD
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-1992
Country	:	US
Telephone Number	:	630-593-5100
Fax Number	:	630-593-5101

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/21/2022

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