Provider Demographics
NPI:1356063135
Name:HARTUNG, SALLY JEAN (PTA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JEAN
Last Name:HARTUNG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-1602
Mailing Address - Country:US
Mailing Address - Phone:636-575-9413
Mailing Address - Fax:
Practice Address - Street 1:1020 WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-3106
Practice Address - Country:US
Practice Address - Phone:636-200-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist