MEDICARE: MRS. GAIL LESLIE HARTWIG 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	2257	CO

General Provider Information

NPI Number	:	1871779603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAIL LESLIE HARTWIG PT

Provider Business Mailing Address
First Line	:	609 CANDICE CT
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-9436
Country	:	US
Telephone Number	:	970-532-2578
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 W TRILBY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4054
Country	:	US
Telephone Number	:	970-226-4909
Fax Number	:

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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