Healthcare Provider Details

I. General information

NPI: 1750409751
Provider Name (Legal Business Name): NICOLE SUZANNE HAMEL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 113TH ST
SEMINOLE FL
33772-4128
US

IV. Provider business mailing address

8215 113TH ST
SEMINOLE FL
33772-4128
US

V. Phone/Fax

Practice location:
  • Phone: 727-393-8482
  • Fax: 727-393-8482
Mailing address:
  • Phone: 727-393-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT18085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: