Provider Demographics
NPI:1346545670
Name:HARTMAN, LUCILLE WYMER (PTA)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:WYMER
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:LUCILLE
Other - Last Name:WYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1775 BOSTON POST ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475
Mailing Address - Country:US
Mailing Address - Phone:860-399-6216
Mailing Address - Fax:860-399-6790
Practice Address - Street 1:1775 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-399-6216
Practice Address - Fax:860-399-6790
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1114172M00000X
PATEI000164172M00000X
VA2306601364172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist