Healthcare Provider Details

I. General information

NPI: 1740939727
Provider Name (Legal Business Name): OLIVIA HARTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 GREENWAY DR STE 500
IRVING TX
75038-2444
US

IV. Provider business mailing address

3608 HIDDEN FOREST DR
FLOWER MOUND TX
75028-8902
US

V. Phone/Fax

Practice location:
  • Phone: 214-467-9787
  • Fax:
Mailing address:
  • Phone: 972-971-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1356957
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: