Provider Demographics
NPI:1194931220
Name:HARTZOG, ERICH LEE (PT)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:LEE
Last Name:HARTZOG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-4012
Mailing Address - Country:US
Mailing Address - Phone:281-723-1184
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PARKWAY SOUTH
Practice Address - Street 2:100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-725-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist