Provider Demographics
NPI:1285808816
Name:HARDESTY, DAVID ANTHONY (LMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ECR 130
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-6567
Mailing Address - Country:US
Mailing Address - Phone:432-620-0296
Mailing Address - Fax:
Practice Address - Street 1:1300 ECR 130
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-6567
Practice Address - Country:US
Practice Address - Phone:432-620-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT010461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist