Provider Demographics
NPI:1437690864
Name:HARTL, AMY (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HARTL
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 W TUPPER ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2145
Mailing Address - Country:US
Mailing Address - Phone:703-472-8278
Mailing Address - Fax:
Practice Address - Street 1:726 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1904
Practice Address - Country:US
Practice Address - Phone:703-472-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029431172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist