Provider Demographics
NPI:1073749511
Name:HARTZELL, LARA ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:ANN
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EDWIN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-8505
Mailing Address - Country:US
Mailing Address - Phone:304-292-0173
Mailing Address - Fax:304-292-0174
Practice Address - Street 1:6 EDWIN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-8505
Practice Address - Country:US
Practice Address - Phone:304-292-0173
Practice Address - Fax:304-292-0174
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist