Provider Demographics
NPI:1447554126
Name:HAMEDANI, ALI (DPT)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:HAMEDANI
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 1:30 HAWTHORNE ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8212
Mailing Address - Country:US
Mailing Address - Phone:802-876-6000
Mailing Address - Fax:802-876-6003
Practice Address - Street 1:30 HAWTHORNE ST
Practice Address - Street 2:SUITE 20
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8212
Practice Address - Country:US
Practice Address - Phone:802-876-6000
Practice Address - Fax:802-876-6003
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0057928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist