Provider Demographics
NPI:1023057064
Name:HAMILTON PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:HAMILTON PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:406-375-0980
Mailing Address - Street 1:336 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3126
Mailing Address - Country:US
Mailing Address - Phone:406-375-0980
Mailing Address - Fax:406-375-9938
Practice Address - Street 1:336 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3126
Practice Address - Country:US
Practice Address - Phone:406-375-0980
Practice Address - Fax:406-375-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH1515OtherRAILROAD MEDICARE
184903000OtherDEPT OF LABOR
000080772OtherMEDICARE B PIN
184903000OtherDEPT OF LABOR
1280780001Medicare NSC