Healthcare Provider Details

I. General information

NPI: 1538313606
Provider Name (Legal Business Name): VICKI RENEE HAMMOND A.T.C., P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2008
Last Update Date: 11/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HARBOR BLVD SUITE 710
ANAHEIM CA
92805-3733
US

IV. Provider business mailing address

6603 MICHELSON ST
LAKEWOOD CA
90713-1755
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-5207
  • Fax:
Mailing address:
  • Phone: 562-925-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT-6149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number029602579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: