Provider Demographics
NPI:1114746286
Name:HARTFORD, JAMAR TYRECE
Entity type:Individual
Prefix:
First Name:JAMAR
Middle Name:TYRECE
Last Name:HARTFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 BELLAMY PL UNIT 302
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-3719
Mailing Address - Country:US
Mailing Address - Phone:254-669-1717
Mailing Address - Fax:
Practice Address - Street 1:1541 BELLAMY PL UNIT 302
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-3719
Practice Address - Country:US
Practice Address - Phone:254-669-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer