MEDICARE: MR. DERVAL HAMILTON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P16119	NC

General Provider Information

NPI Number	:	1356898605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DERVAL HAMILTON PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 1890
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-1890
Country	:	US
Telephone Number	:	828-757-6226
Fax Number	:	828-757-6289

Provider Business Practice Location Address
First Line	:	1031 MORGANTON BLVD SW
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-5677
Country	:	US
Telephone Number	:	828-757-6226
Fax Number	:	828-757-6289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2016
Last Update Date	:	09/03/2016

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