Provider Demographics
NPI:1639835218
Name:HARTFIELD, KAMERON J (PTA)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:J
Last Name:HARTFIELD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-7495
Mailing Address - Country:US
Mailing Address - Phone:512-581-8139
Mailing Address - Fax:
Practice Address - Street 1:14701 S PADRE ISLAND DR STE 107
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6261
Practice Address - Country:US
Practice Address - Phone:361-589-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166347225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant