MEDICARE: JENNIFER RENEE HAMILTON 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	P11187	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11187	OTHER	NC	NC STATE LICENCE

General Provider Information

NPI Number	:	1821296989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RENEE HAMILTON DPT

Provider Business Mailing Address
First Line	:	6000 RAMSEY ST STE 108
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-7189
Country	:	US
Telephone Number	:	910-484-3332
Fax Number	:	910-483-7301

Provider Business Practice Location Address
First Line	:	6000 RAMSEY ST STE 108
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-7189
Country	:	US
Telephone Number	:	910-484-3332
Fax Number	:	910-483-7301

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	01/03/2025

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