Provider Demographics
NPI:1861677155
Name:HARTLEY, THERESA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ROSE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3337
Mailing Address - Country:US
Mailing Address - Phone:727-623-0992
Mailing Address - Fax:
Practice Address - Street 1:2647 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3337
Practice Address - Country:US
Practice Address - Phone:727-623-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor