Provider Demographics
NPI:1548677503
Name:HAMILTON, PEGGY (RPTA)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:LYNN
Other - Last Name:O'DELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPTA
Mailing Address - Street 1:15477 N 2000TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62480-2023
Mailing Address - Country:US
Mailing Address - Phone:618-553-9921
Mailing Address - Fax:618-544-7039
Practice Address - Street 1:600 ROBINWOOD DRIVE
Practice Address - Street 2:HERITAGE HEALTH, THERAPY, AND SENIOR CARE
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454
Practice Address - Country:US
Practice Address - Phone:618-544-3192
Practice Address - Fax:618-544-7039
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.002183225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant