Provider Demographics
NPI:1588711600
Name:HAMILTON, CAROLYN STEWART (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:STEWART
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:LEE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 CROW CANYON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1639
Mailing Address - Country:US
Mailing Address - Phone:925-820-5739
Mailing Address - Fax:925-831-6146
Practice Address - Street 1:2817 CROW CANYON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1639
Practice Address - Country:US
Practice Address - Phone:925-838-9846
Practice Address - Fax:925-838-3254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT124721OtherPPIN
CA1588711600OtherNPI
CAR24553Medicare UPIN