Provider Demographics
NPI:1265467039
Name:HARTENSTEIN, DREW S (PT)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:S
Last Name:HARTENSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 W AVENUE J4
Mailing Address - Street 2:#104
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4246
Mailing Address - Country:US
Mailing Address - Phone:661-949-6649
Mailing Address - Fax:661-949-9431
Practice Address - Street 1:936 W AVENUE J4
Practice Address - Street 2:#104
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4246
Practice Address - Country:US
Practice Address - Phone:661-949-6649
Practice Address - Fax:661-949-9431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT17364Medicare PIN