Provider Demographics
NPI:1962708768
Name:HARTUNG, JASON MICHAEL (PTA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHAEL
Last Name:HARTUNG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 CENTRAL ST
Mailing Address - Street 2:APT 301
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-8312
Mailing Address - Country:US
Mailing Address - Phone:978-602-4746
Mailing Address - Fax:
Practice Address - Street 1:255 LEBANON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7828
Practice Address - Country:US
Practice Address - Phone:413-499-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8463171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor