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NPI Code Detail

MEDICARE: MR. THOMAS WADE HAMMOND CMT

MEDICARE:  MR. THOMAS WADE HAMMOND  CMT
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
1225700000XMassage Therapist59099CA

General Provider Information

NPI Number : 1679089254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS WADE HAMMOND CMT
Provider Business Mailing Address
First Line : 9171 ETCHINGS WAY
Second Line :
City : LAKESIDE
State : CA
Zip : 92040-5114
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 457 N ELM ST
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-3001
Country : US
Telephone Number : 760-204-8919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2017
Last Update Date : 12/19/2017

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Directions to “ MR. THOMAS WADE HAMMOND CMT” Practice Location

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