MEDICARE: CYNTHIA LEE HARTMANN HURT 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	174400000X	Specialist	1869-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1869-024	OTHER	WY	PT STATE LICNSE NUMBER

General Provider Information

NPI Number	:	1265550735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LEE HARTMANN HURT PT, DPT

Provider Business Mailing Address
First Line	:	11460 FLAGG RIVER RD
Second Line	:
City	:	PORT WING
State	:	WI
Zip	:	54865-5706
Country	:	US
Telephone Number	:	715-774-3528
Fax Number	:

Provider Business Practice Location Address
First Line	:	COOPER WEISBERG SCHOOL
Second Line	:	1807 MISSOURI AVE.
City	:	SUPERIOR
State	:	WI
Zip	:	54880-2225
Country	:	US
Telephone Number	:	715-394-8790
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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