Provider Demographics
NPI:1144277963
Name:HARTWIG, DALLAS S (PT)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:S
Last Name:HARTWIG
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:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0396
Mailing Address - Country:US
Mailing Address - Phone:207-373-1101
Mailing Address - Fax:207-373-1109
Practice Address - Street 1:34 HENNESSEY AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2333
Practice Address - Country:US
Practice Address - Phone:207-373-1101
Practice Address - Fax:207-373-1109
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist