Provider Demographics
NPI:1265615645
Name:HARTMAN, MICHAEL JUSTIN (PTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N 18TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1547
Mailing Address - Country:US
Mailing Address - Phone:712-542-7393
Mailing Address - Fax:712-542-8285
Practice Address - Street 1:223 N 18TH ST
Practice Address - Street 2:APT 1
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1547
Practice Address - Country:US
Practice Address - Phone:712-542-7393
Practice Address - Fax:712-542-8285
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01031225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant