Healthcare Provider Details

I. General information

NPI: 1992636005
Provider Name (Legal Business Name): DOMENIC HARTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 PEORIA ST
AURORA CO
80010-1483
US

IV. Provider business mailing address

77 E THOMAS RD
PHOENIX AZ
85012-3115
US

V. Phone/Fax

Practice location:
  • Phone: 303-365-4646
  • Fax:
Mailing address:
  • Phone: 602-878-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021303
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: