Provider Demographics
NPI:1700175742
Name:HAMYLAK, KEVIN (DPT)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HAMYLAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LEDGEWOOD RD
Mailing Address - Street 2:APARTMENT 507
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6602
Mailing Address - Country:US
Mailing Address - Phone:860-922-4208
Mailing Address - Fax:
Practice Address - Street 1:668 BANK ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5040
Practice Address - Country:US
Practice Address - Phone:860-442-4600
Practice Address - Fax:860-442-3169
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist