Provider Demographics
NPI:1679883649
Name:HAMILTON, PAUL XAVIER (CMT, MMS)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:XAVIER
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:CMT, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-2902
Mailing Address - Country:US
Mailing Address - Phone:954-692-4555
Mailing Address - Fax:954-597-6112
Practice Address - Street 1:3511 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3331
Practice Address - Country:US
Practice Address - Phone:954-692-4555
Practice Address - Fax:954-597-6112
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45141133N00000X, 173C00000X, 174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist