Basic Information
| Provider Information | |||||||||
| NPI: | 1184886590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | DANETTE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 305 | ||||||||
| Address2: | |||||||||
| City: | IDAMAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265760305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042877252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 BAKERS RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265081459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042850692 | ||||||||
| FaxNumber: | 3042850693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 001549 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.