Provider Demographics
NPI:1770934614
Name:HARTLE, ROBERT TODD (DA, CMT)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TODD
Last Name:HARTLE
Suffix:
Gender:M
Credentials:DA, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 MAIN ST
Mailing Address - Street 2:APT 1070
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-3201
Mailing Address - Country:US
Mailing Address - Phone:949-351-4714
Mailing Address - Fax:
Practice Address - Street 1:1600 DOVE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2432
Practice Address - Country:US
Practice Address - Phone:949-502-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist