MEDICARE: HARTLEY HEALTHCARE SERVICES, INC

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	225200000X	Physical Therapy Assistant	PTA00002284	FL

General Provider Information

NPI Number	:	1902937477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARTLEY HEALTHCARE SERVICES, INC

Provider Business Mailing 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

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	:	OWNER
Name	:	DR. DIANE K HARTLEY
Credential	:	DPT
Telephone Number	:	727-527-2100

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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