Provider Demographics
NPI:1477629459
Name:HARTWIG, DEANA T (PTA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:T
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:T
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6301 FOREST HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4137
Mailing Address - Country:US
Mailing Address - Phone:505-823-8350
Mailing Address - Fax:505-823-8355
Practice Address - Street 1:6301 FOREST HILLS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4137
Practice Address - Country:US
Practice Address - Phone:505-823-8350
Practice Address - Fax:505-823-8355
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0495225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant