Provider Demographics
NPI:1144766536
Name:HARTIGAN, ROBERTA (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:HARTIGAN
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:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0722
Mailing Address - Country:US
Mailing Address - Phone:207-864-3332
Mailing Address - Fax:207-864-9224
Practice Address - Street 1:25 DALLAS HILL ROAD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970
Practice Address - Country:US
Practice Address - Phone:207-864-3332
Practice Address - Fax:207-864-9224
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA2146OtherMAINE STATE PTA LICENSE NUMBER
MEPA2146OtherSTATE LICENSE NUMBER