Provider Demographics
NPI:1215098751
Name:HARTMAN, LOREN JAY (PT)
Entity type:Individual
Prefix:MR
First Name:LOREN
Middle Name:JAY
Last Name:HARTMAN
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 1:69954 COUNTY ROAD 11
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-9420
Mailing Address - Country:US
Mailing Address - Phone:574-773-7733
Mailing Address - Fax:574-773-7133
Practice Address - Street 1:69954 COUNTY ROAD 11
Practice Address - Street 2:SUITE A
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-9420
Practice Address - Country:US
Practice Address - Phone:574-773-7733
Practice Address - Fax:574-773-7133
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003793A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000195425OtherPHYSICAL THERAPY
IN216390AMedicare ID - Type UnspecifiedPHYSICAL THERAPY