Provider Demographics
NPI:1205153103
Name:HARTIN, MICHAEL A (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:HARTIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 AURORA AVE
Mailing Address - Street 2:41
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2211
Mailing Address - Country:US
Mailing Address - Phone:720-329-5553
Mailing Address - Fax:
Practice Address - Street 1:2898 AURORA AVE
Practice Address - Street 2:41
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2211
Practice Address - Country:US
Practice Address - Phone:720-329-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist