Provider Demographics
NPI:1871779603
Name:HARTWIG, GAIL LESLIE (PT)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LESLIE
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CANDICE CT
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-9436
Mailing Address - Country:US
Mailing Address - Phone:970-532-2578
Mailing Address - Fax:
Practice Address - Street 1:508 W TRILBY RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4054
Practice Address - Country:US
Practice Address - Phone:970-226-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist