Provider Demographics
NPI:1669142295
Name:HARDEMAN, MARIAH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:
Last Name:HARDEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SHELTIE LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3409
Mailing Address - Country:US
Mailing Address - Phone:682-465-0414
Mailing Address - Fax:
Practice Address - Street 1:139 ESTRELLA XING
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-7055
Practice Address - Country:US
Practice Address - Phone:512-863-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist