Provider Demographics
NPI:1841321569
Name:HAMBLETON, MATTHEW D (ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:HAMBLETON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E JOLLY RD APT D3
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6686
Mailing Address - Country:US
Mailing Address - Phone:517-449-1835
Mailing Address - Fax:
Practice Address - Street 1:121 E JOLLY RD APT D3
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6686
Practice Address - Country:US
Practice Address - Phone:517-449-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer