MEDICARE: MR. NORMAN G. HARDMAN PT

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	PT 25540	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPT 255400	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1306840657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORMAN G. HARDMAN PT

Provider Business Mailing Address
First Line	:	4415 AVOCADO BLVD
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-7129
Country	:	US
Telephone Number	:	619-417-9532
Fax Number	:

Provider Business Practice Location Address
First Line	:	6280 JACKSON DR STE 4C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3436
Country	:	US
Telephone Number	:	619-417-9532
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/16/2009

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Directions to “ MR. NORMAN G. HARDMAN PT” Practice Location

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