Healthcare Provider Details

I. General information

NPI: 1346363348
Provider Name (Legal Business Name): JUSTIN WADE HAMILTON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DE SOTO AVE KAISER PERMANENTE
WOODLAND HILLS CA
91367-6701
US

IV. Provider business mailing address

2636 SUNSHINE VALLEY CT
SIMI VALLEY CA
93063-6303
US

V. Phone/Fax

Practice location:
  • Phone: 818-719-2939
  • Fax: 818-719-3045
Mailing address:
  • Phone: 805-306-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number24839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: