MEDICARE: DR. DIANE K HARTLEY PT, DPT, RCMT

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	2251X0800X	Orthopedic Physical Therapist	PT1881	FL

General Provider Information

NPI Number	:	1689713562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE K HARTLEY PT, DPT, RCMT

Provider Business Mailing Address
First Line	:	413 MONTE CRISTO BLVD
Second Line	:
City	:	TIERRA VERDE
State	:	FL
Zip	:	33715-1840
Country	:	US
Telephone Number	:	727-866-8194
Fax Number	:	727-521-3710

Provider Business Practice Location Address
First Line	:	6613 49TH ST
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5728
Country	:	US
Telephone Number	:	727-527-2100
Fax Number	:	727-521-3710

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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