MEDICARE: MS. ELISE ANN HARTENSTEIN 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	2986	NM
2	225100000X	Physical Therapist	1123057	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2986	OTHER	NM	STATE OF NEW MEXICO

General Provider Information

NPI Number	:	1629054804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISE ANN HARTENSTEIN PT

Provider Business Mailing Address
First Line	:	450 ROBERTS DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79118-3742
Country	:	US
Telephone Number	:	575-415-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 ROBERTS DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79118-3742
Country	:	US
Telephone Number	:	575-415-1791
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	12/04/2018

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