Healthcare Provider Details

I. General information

NPI: 1518822907
Provider Name (Legal Business Name): GINA DE ETTE HAMILTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 10TH AVE SE STE 115
CEDAR RAPIDS IA
52401-2331
US

IV. Provider business mailing address

5192 SUTTON RD
CENTRAL CITY IA
52214-9711
US

V. Phone/Fax

Practice location:
  • Phone: 319-775-0117
  • Fax:
Mailing address:
  • Phone: 319-551-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number04089
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: