Provider Demographics
NPI:1104913755
Name:HAMRE, GARY STEVEN (PT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:STEVEN
Last Name:HAMRE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 CORONADO BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3228
Mailing Address - Country:US
Mailing Address - Phone:210-659-2154
Mailing Address - Fax:210-659-2405
Practice Address - Street 1:970 CORONADO BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3228
Practice Address - Country:US
Practice Address - Phone:210-659-2154
Practice Address - Fax:210-659-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10864782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650540Medicare ID - Type UnspecifiedPHYSICAL THERAPIST