Healthcare Provider Details

I. General information

NPI: 1962723254
Provider Name (Legal Business Name): LAURA BRITTON HAMILTON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E OCEAN AVE
LOMPOC CA
93436-7096
US

IV. Provider business mailing address

1101 E OCEAN AVE
LOMPOC CA
93436-7096
US

V. Phone/Fax

Practice location:
  • Phone: 805-733-8365
  • Fax: 805-735-2604
Mailing address:
  • Phone: 805-733-8365
  • Fax: 805-735-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36801
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: