MEDICARE: THOMAS WESLEY HARTLAGE PT, 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	10358	SC

General Provider Information

NPI Number	:	1265003743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WESLEY HARTLAGE PT, DPT

Provider Business Mailing Address
First Line	:	374 COUNSELORS WAY APT 303
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8648
Country	:	US
Telephone Number	:	859-329-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	4543 CHARLOTTE HWY STE 11
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-7057
Country	:	US
Telephone Number	:	803-831-1454
Fax Number	:

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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