Provider Demographics
NPI:1619037959
Name:HARGENS, DANI CARTNER (PT)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:CARTNER
Last Name:HARGENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 S. MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-5758
Mailing Address - Country:US
Mailing Address - Phone:765-751-3361
Mailing Address - Fax:765-751-3369
Practice Address - Street 1:3600 W. BETHEL AVE.
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5407
Practice Address - Country:US
Practice Address - Phone:765-213-3870
Practice Address - Fax:765-213-3888
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009069A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200840120Medicaid