Provider Demographics
NPI:1306840657
Name:HARDMAN, NORMAN G (PT)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:G
Last Name:HARDMAN
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 1:4415 AVOCADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7129
Mailing Address - Country:US
Mailing Address - Phone:619-417-9532
Mailing Address - Fax:
Practice Address - Street 1:6280 JACKSON DR STE 4C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3436
Practice Address - Country:US
Practice Address - Phone:619-417-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 255400OtherBLUE SHIELD
CAW17072Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAOPT 255400OtherBLUE SHIELD