Healthcare Provider Details

I. General information

NPI: 1447652763
Provider Name (Legal Business Name): LAMONT HUTCHINSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14775 W YORKSHIRE DR
SURPRISE AZ
85374-7224
US

IV. Provider business mailing address

14775 W YORKSHIRE DR
SURPRISE AZ
85374-7224
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-9698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8290A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: