Provider Demographics
NPI:1659750891
Name:HARTWICK, DAVID LYNN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LYNN
Last Name:HARTWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6145
Mailing Address - Country:US
Mailing Address - Phone:916-541-4678
Mailing Address - Fax:
Practice Address - Street 1:791 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6145
Practice Address - Country:US
Practice Address - Phone:916-541-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist