MEDICARE: DR. ROBERT HARTNETT III 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	PT297176	CA

General Provider Information

NPI Number	:	1396392536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT HARTNETT III PT, DPT

Provider Business Mailing Address
First Line	:	11818 ASTI DR
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-9004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5901
Country	:	US
Telephone Number	:	619-888-5838
Fax Number	:

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

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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