Provider Demographics
NPI:1467676304
Name:HARTHORNE, GARRETT WESLEY (MSPT)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:WESLEY
Last Name:HARTHORNE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LYMAN HERRICK RD
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-4033
Mailing Address - Country:US
Mailing Address - Phone:207-527-2191
Mailing Address - Fax:
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5643
Practice Address - Country:US
Practice Address - Phone:207-743-1562
Practice Address - Fax:207-743-1577
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist