MEDICARE: MR. SHANE MICHAEL HARTMAN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1346	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093728206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANE MICHAEL HARTMAN MPT

Provider Business Mailing Address
First Line	:	2297 KANSAS AVE SE STE 4
Second Line	:
City	:	HURON
State	:	SD
Zip	:	57350-4274
Country	:	US
Telephone Number	:	605-554-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2297 KANSAS AVE SE STE 4
Second Line	:
City	:	HURON
State	:	SD
Zip	:	57350-4274
Country	:	US
Telephone Number	:	605-354-1546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	11/02/2020

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