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NPI Code Detail

MEDICARE: MS. LAURIE HAZEL HARDIN CMT

MEDICARE:  MS. LAURIE HAZEL HARDIN  CMT
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
1225700000XMassage TherapistMT20903061IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MT20903061OTHERINMASSAGE THERAPIST LICENSE

General Provider Information

NPI Number : 1205128782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURIE HAZEL HARDIN CMT
Provider Business Mailing Address
First Line : 16765 AULTON DR
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-3949
Country : US
Telephone Number : 317-966-8646
Fax Number :
Provider Business Practice Location Address
First Line : 9247 N MERIDIAN ST
Second Line : SUITE 210
City : INDIANAPOLIS
State : IN
Zip : 46260-1879
Country : US
Telephone Number : 317-966-8646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2011
Last Update Date : 05/03/2011

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Directions to “ MS. LAURIE HAZEL HARDIN CMT” Practice Location

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