Provider Demographics
NPI:1255882114
Name:HAMMOND, JACKLYN (DPT)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3711
Mailing Address - Country:US
Mailing Address - Phone:586-943-1717
Mailing Address - Fax:
Practice Address - Street 1:2041 RIVER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1006
Practice Address - Country:US
Practice Address - Phone:586-943-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013695A225100000X
KY006993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist