Provider Demographics
NPI:1336138353
Name:HARTZLER, MATTHEW A (MPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:HARTZLER
Suffix:
Gender:M
Credentials:MPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8702
Mailing Address - Country:US
Mailing Address - Phone:330-335-4200
Mailing Address - Fax:330-335-7131
Practice Address - Street 1:145 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8702
Practice Address - Country:US
Practice Address - Phone:330-335-4200
Practice Address - Fax:330-335-7131
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT110262251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2550583Medicaid
OH2550583Medicaid