Provider Demographics
NPI:1083121727
Name:HAMILTON, KATHERINE (PTA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 SW BARBER ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7397
Mailing Address - Country:US
Mailing Address - Phone:904-654-7420
Mailing Address - Fax:
Practice Address - Street 1:11850 SW 67TH AVE STE 145
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8961
Practice Address - Country:US
Practice Address - Phone:503-749-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003956225200000X
OR9845225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant