Provider Demographics
NPI:1588961247
Name:HARTLEY HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:HARTLEY HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:727-527-2100
Mailing Address - Street 1:5791 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2107
Mailing Address - Country:US
Mailing Address - Phone:727-527-2100
Mailing Address - Fax:727-521-3710
Practice Address - Street 1:431 SOUTHWEST BLVD N
Practice Address - Street 2:SUITE
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1399
Practice Address - Country:US
Practice Address - Phone:727-498-5314
Practice Address - Fax:727-521-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106969261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106969OtherMEDICARE ID TYPE UNSPECIFIED