Provider Demographics
NPI:1063937837
Name:HARTZELL, NOLAN (ATC)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:HARTZELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9733
Mailing Address - Country:US
Mailing Address - Phone:716-982-3684
Mailing Address - Fax:
Practice Address - Street 1:2121 I ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20052-0086
Practice Address - Country:US
Practice Address - Phone:716-982-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer