Healthcare Provider Details

I. General information

NPI: 1356644629
Provider Name (Legal Business Name): CASEY PAUL HAMILTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BRODIE LN STE 640
SUNSET VALLEY TX
78745-2551
US

IV. Provider business mailing address

800 CRESCENT CENTRE DR STE 300
FRANKLIN TN
37067-7285
US

V. Phone/Fax

Practice location:
  • Phone: 512-580-3055
  • Fax: 512-580-3056
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1187640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: