Basic Information
| Provider Information | |||||||||
| NPI: | 1972512663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTMAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14220 NORTHBROOK | ||||||||
| Address2: | STE 700 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108228807 | ||||||||
| FaxNumber: | 2108228863 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 MADISON OAK | ||||||||
| Address2: | STE 360 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105454006 | ||||||||
| FaxNumber: | 2105454096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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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 | 1020931 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 037026401 | 05 | TX | MEDICAID | 80440T | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 0039869 | 01 | TX | BLUE LINK NO. | OTHER | 0370264-01 | 05 | TX | MEDICAID |