Provider Demographics
NPI:1124345475
Name:TSEGAYE, HAMRAWIT (CMT)
Entity type:Individual
Prefix:
First Name:HAMRAWIT
Middle Name:
Last Name:TSEGAYE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 PIERCE CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5768
Mailing Address - Country:US
Mailing Address - Phone:770-912-1204
Mailing Address - Fax:
Practice Address - Street 1:4880 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 13
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2938
Practice Address - Country:US
Practice Address - Phone:770-912-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003241172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist