Provider Demographics
NPI:1548372014
Name:HAMMILL, JEAN M (PT, DPT, MA, OCS,ATC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:HAMMILL
Suffix:
Gender:F
Credentials:PT, DPT, MA, OCS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 44TH ST
Mailing Address - Street 2:SUITE 10,000
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3846
Mailing Address - Country:US
Mailing Address - Phone:319-373-7311
Mailing Address - Fax:319-373-7313
Practice Address - Street 1:999 44TH ST
Practice Address - Street 2:SUITE 10,000
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3846
Practice Address - Country:US
Practice Address - Phone:319-373-7311
Practice Address - Fax:319-373-7313
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA878225100000X
IA00878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0143966Medicaid
IA54255OtherWELLMARK BLUE CROSS/BLUE
54255Medicare PIN