Healthcare Provider Details

I. General information

NPI: 1417364837
Provider Name (Legal Business Name): MS. NELDA RENEE HAMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. NELDA RENEE HAMPTON

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WYNDHAM DR PRIVATE HOUSE
CRESCO PA
18326-7450
US

IV. Provider business mailing address

318 WYNDHAM DRIVE
CRESCO PA
18326
US

V. Phone/Fax

Practice location:
  • Phone: 347-528-4316
  • Fax:
Mailing address:
  • Phone: 347-528-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004390-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: