Provider Demographics
NPI:1942573472
Name:HARTWELL, JANICE ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ANNE
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17780 CALOOSA RD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-3301
Mailing Address - Country:US
Mailing Address - Phone:239-332-3356
Mailing Address - Fax:
Practice Address - Street 1:7680 CAMBRIDGE MANOR PL
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3671
Practice Address - Country:US
Practice Address - Phone:239-288-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA46855OtherFLORIDA LICENSE NUMBER