Provider Demographics
NPI:1962967182
Name:HAMILTON, TAIYAN (MMP, LMT)
Entity type:Individual
Prefix:
First Name:TAIYAN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77549-0482
Mailing Address - Country:US
Mailing Address - Phone:314-413-7645
Mailing Address - Fax:
Practice Address - Street 1:4501 S GENERAL BRUCE DR STE 12
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1466
Practice Address - Country:US
Practice Address - Phone:254-342-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist