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General NPI Number Information
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NPI Number | 1902860687
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Entity Type | Individual
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Provider Name | JOHN MARK HAMM PT
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13940 N US HIGHWAY 441 SUITE 702
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City | LADY LAKE
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State | FL
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Zip | 32159-8908
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Country | US
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Telephone | 352-751-1095
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 490210
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City | LEESBURG
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State | FL
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Zip | 34749-0210
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Country | US
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Telephone | 800-778-6623
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Fax | 352-750-5029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5306
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License Number State | FL
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