Healthcare Provider Details

I. General information

NPI: 1285607598
Provider Name (Legal Business Name): DAVE LYNN HAMMONS I ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVE HAMMONS ATC

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 UNIVERSITY DR
BOISE ID
83725-1710
US

IV. Provider business mailing address

5412 N ISLA AVE
MERIDIAN ID
83646-5852
US

V. Phone/Fax

Practice location:
  • Phone: 208-426-4863
  • Fax:
Mailing address:
  • Phone: 208-870-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-333
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: