Provider Demographics
NPI:1609993245
Name:HAMRICK, JEAN NIRA (PTA)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:NIRA
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 FOXCROFT RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3720
Mailing Address - Country:US
Mailing Address - Phone:864-288-0054
Mailing Address - Fax:
Practice Address - Street 1:200 PLAZA CIR
Practice Address - Street 2:SUITE D
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7560
Practice Address - Country:US
Practice Address - Phone:864-833-2368
Practice Address - Fax:864-833-0458
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant