Provider Demographics
NPI:1457165748
Name:HARTLEY, JEREMIAH JAMES (LMT)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JAMES
Last Name:HARTLEY
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 1:800 N WIN CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6741
Mailing Address - Country:US
Mailing Address - Phone:907-240-1266
Mailing Address - Fax:
Practice Address - Street 1:591 N KNIK ST STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7062
Practice Address - Country:US
Practice Address - Phone:907-308-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK207404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist