MEDICARE: KAREN ELIZABETH HARTSELL DPT

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	PT6487	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R4M	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1235315490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ELIZABETH HARTSELL DPT

Provider Business Mailing Address
First Line	:	1536 E SILVER SPRINGS BLVD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6804
Country	:	US
Telephone Number	:	352-351-4141
Fax Number	:	352-351-1889

Provider Business Practice Location Address
First Line	:	1536 E SILVER SPRINGS BLVD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6804
Country	:	US
Telephone Number	:	352-351-4141
Fax Number	:	352-351-1889

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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