Provider Demographics
NPI:1083911887
Name:HARTMAN, DOTTIE A (LMT)
Entity Type:Individual
Prefix:
First Name:DOTTIE
Middle Name:A
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 SW ALACHUA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-7010
Mailing Address - Country:US
Mailing Address - Phone:386-719-8887
Mailing Address - Fax:
Practice Address - Street 1:272 SW ALACHUA AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7010
Practice Address - Country:US
Practice Address - Phone:386-719-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist