Healthcare Provider Details

I. General information

NPI: 1679883649
Provider Name (Legal Business Name): PAUL XAVIER HAMILTON CMT, MMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 W COMMERCIAL BLVD SUITE 212
FT LAUDERDALE FL
33309-3331
US

IV. Provider business mailing address

3411 BARTON RD
POMPANO BEACH FL
33062-2902
US

V. Phone/Fax

Practice location:
  • Phone: 954-692-4555
  • Fax: 954-597-6112
Mailing address:
  • Phone: 954-692-4555
  • Fax: 954-597-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number45141
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number45141
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number45141
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number45141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: