Healthcare Provider Details

I. General information

NPI: 1528105103
Provider Name (Legal Business Name): HAMILTON PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 CROW CANYON RD SUITE 104
SAN RAMON CA
94583-1639
US

IV. Provider business mailing address

2817 CROW CANYON RD SUITE 104
SAN RAMON CA
94583-1639
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-9846
  • Fax: 925-838-3254
Mailing address:
  • Phone: 925-838-9846
  • Fax: 925-838-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT12472
License Number StateCA

VIII. Authorized Official

Name: GAIL ORTIZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 925-838-9846