Provider Demographics
NPI:1972316131
Name:HARTLINE, NOAH
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:HARTLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 FAIRBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-3502
Mailing Address - Country:US
Mailing Address - Phone:318-935-9075
Mailing Address - Fax:318-935-9076
Practice Address - Street 1:235 FAIRBURN AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-3502
Practice Address - Country:US
Practice Address - Phone:318-935-9075
Practice Address - Fax:318-935-9076
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist