Basic Information
| Provider Information | |||||||||
| NPI: | 1184900565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMACK | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURKHOLDER | ||||||||
| OtherFirstName: | ABBY | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5347 N WILLIAMS CREEK DR | ||||||||
| Address2: | |||||||||
| City: | KING GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224856210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404211525 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 MCKINNEY BLVD | ||||||||
| Address2: | |||||||||
| City: | COLONIAL BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224431237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042242222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2011 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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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 | 2305206271 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.