Provider Demographics
NPI:1265003743
Name:HARTLAGE, THOMAS WESLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WESLEY
Last Name:HARTLAGE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 COUNSELORS WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8648
Mailing Address - Country:US
Mailing Address - Phone:859-329-7788
Mailing Address - Fax:
Practice Address - Street 1:4543 CHARLOTTE HWY STE 11
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-7057
Practice Address - Country:US
Practice Address - Phone:803-831-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist