Provider Demographics
NPI:1528368628
Name:HARTSELL, ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HARTSELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SW ARUBA BAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3425
Mailing Address - Country:US
Mailing Address - Phone:772-828-1599
Mailing Address - Fax:
Practice Address - Street 1:1680 SW BAYSHORE BLVD
Practice Address - Street 2:STUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3500
Practice Address - Country:US
Practice Address - Phone:772-828-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist