Healthcare Provider Details

I. General information

NPI: 1497367049
Provider Name (Legal Business Name): KRISTA HAMM PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 59TH ST W
BRADENTON FL
34209-4602
US

IV. Provider business mailing address

5130 CENTRAL SARASOTA PKWY APT 301
SARASOTA FL
34238-7620
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-1000
  • Fax:
Mailing address:
  • Phone: 708-227-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA30268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: