Provider Demographics
NPI:1376383786
Name:HARTMAN, GRACE LEA (DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LEA
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3821
Mailing Address - Country:US
Mailing Address - Phone:701-415-0000
Mailing Address - Fax:833-969-0195
Practice Address - Street 1:1810 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3821
Practice Address - Country:US
Practice Address - Phone:701-415-0000
Practice Address - Fax:833-969-0195
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist