Healthcare Provider Details

I. General information

NPI: 1205128782
Provider Name (Legal Business Name): LAURIE HAZEL HARDIN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9247 N MERIDIAN ST SUITE 210
INDIANAPOLIS IN
46260-1879
US

IV. Provider business mailing address

16765 AULTON DR
NOBLESVILLE IN
46060-3949
US

V. Phone/Fax

Practice location:
  • Phone: 317-966-8646
  • Fax:
Mailing address:
  • Phone: 317-966-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20903061
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: