Basic Information
| Provider Information | |||||||||
| NPI: | 1255534947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTMAN | ||||||||
| FirstName: | DWIGHT | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 JONES ST | ||||||||
| Address2: | |||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020432002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817402027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 WOOD RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021842401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815356053 | ||||||||
| FaxNumber: | 7815356056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 12/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11919 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0314587 | 05 | MA | MEDICAID |