Healthcare Provider Details

I. General information

NPI: 1760442347
Provider Name (Legal Business Name): MICHAEL B HAMMOND PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER PHYSICAL THERAPY SECTION
FORT LEWIS WA
98431
US

IV. Provider business mailing address

4432 MEMORY LN W
UNIVERSITY PLACE WA
98466-1129
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0780
  • Fax:
Mailing address:
  • Phone: 253-460-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: