Provider Demographics
NPI:1982142279
Name:HAMILTON, MATTHEW KENNETH (THD, CFT, SSN,)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KENNETH
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:THD, CFT, SSN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 MYDLAND RD LOT 171
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2138
Mailing Address - Country:US
Mailing Address - Phone:307-752-9077
Mailing Address - Fax:
Practice Address - Street 1:1898 FORT RD
Practice Address - Street 2:BLDG 2 WELLNESS CENTER
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8320
Practice Address - Country:US
Practice Address - Phone:307-675-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer