=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114491644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID HAMILTON PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2019
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1026 MCFARLAND ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-522-3837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27193
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-0136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-435-3237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 11027
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------