Provider Demographics
NPI:1629801832
Name:HARTEIS, BLAINE MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:MICHAEL
Last Name:HARTEIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 NEW GERMANY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958-5605
Mailing Address - Country:US
Mailing Address - Phone:814-525-9768
Mailing Address - Fax:
Practice Address - Street 1:2010 SHELLY DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2388
Practice Address - Country:US
Practice Address - Phone:724-349-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist