Provider Demographics
NPI:1255534947
Name:HARTMAN, DWIGHT MICHAEL
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:MICHAEL
Last Name:HARTMAN
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 1:22 JONES ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2002
Mailing Address - Country:US
Mailing Address - Phone:781-740-2027
Mailing Address - Fax:
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:781-535-6053
Practice Address - Fax:781-535-6056
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0314587Medicaid
MAY6811501Medicare PIN