Provider Demographics
NPI:1689713562
Name:HARTLEY, DIANE K (PT, DPT, RCMT)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:K
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:PT, DPT, RCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MONTE CRISTO BLVD
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1840
Mailing Address - Country:US
Mailing Address - Phone:727-866-8194
Mailing Address - Fax:727-521-3710
Practice Address - Street 1:6613 49TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5728
Practice Address - Country:US
Practice Address - Phone:727-527-2100
Practice Address - Fax:727-521-3710
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR11Medicare ID - Type Unspecified