Provider Demographics
NPI:1992932289
Name:HAMM, JONATHAN (PT)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:HAMM
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 1:209 N CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2181
Mailing Address - Country:US
Mailing Address - Phone:309-886-2305
Mailing Address - Fax:309-444-3893
Practice Address - Street 1:209 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2181
Practice Address - Country:US
Practice Address - Phone:309-886-2305
Practice Address - Fax:309-444-3893
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01087992OtherRR MEDICARE
ILP01087992OtherRR MEDICARE