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NPI Code Detail

MEDICARE: BLAKE AUSTIN HAMPTON DPT

MEDICARE: BLAKE AUSTIN HAMPTON 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
12251S0007XSports Physical TherapistPT012527GA
22251X0800XOrthopedic Physical TherapistPT012527GA
3225100000XPhysical TherapistPT012527GA

General Provider Information

NPI Number : 1699229617
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE AUSTIN HAMPTON DPT
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number : 586-541-3735
Provider Business Practice Location Address
First Line : 1825 ROCKBRIDGE RD STE 15A
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30087-3301
Country : US
Telephone Number : 470-977-2100
Fax Number : 470-977-2101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2016
Last Update Date : 03/07/2024

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Directions to “ BLAKE AUSTIN HAMPTON DPT” Practice Location

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