Provider Demographics
NPI:1982778445
Name:HAMILTON, RICHARD MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N END AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1616
Mailing Address - Country:US
Mailing Address - Phone:716-876-1961
Mailing Address - Fax:716-876-1961
Practice Address - Street 1:138 N END AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1616
Practice Address - Country:US
Practice Address - Phone:716-876-1961
Practice Address - Fax:716-876-1961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021470-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist