Provider Demographics
NPI:1720159197
Name:HAMILTON, HEIDI ANN (PT, DPT, ATC, MTC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PT, DPT, ATC, MTC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:LALLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:9097 E DESERT COVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6276
Practice Address - Country:US
Practice Address - Phone:480-860-4298
Practice Address - Fax:480-860-0356
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist