Provider Demographics
NPI:1386691210
Name:HARTING, TREVOR LEE (PT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:LEE
Last Name:HARTING
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 1:14884 KIRKWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-824-5027
Mailing Address - Fax:218-824-8011
Practice Address - Street 1:14884 KIRKWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-824-5027
Practice Address - Fax:218-824-8011
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650001498Medicare ID - Type UnspecifiedINDIVIDUAL ID