Provider Demographics
NPI:1467416115
Name:HATTERMANN, DOUGLAS J (PT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:HATTERMANN
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:PO BOX 16681
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4061
Mailing Address - Country:US
Mailing Address - Phone:770-892-0273
Mailing Address - Fax:470-878-1495
Practice Address - Street 1:135 N PARK PL STE 210
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7209
Practice Address - Country:US
Practice Address - Phone:770-892-0273
Practice Address - Fax:470-878-1495
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0072102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCDXMedicare ID - Type Unspecified