Provider Demographics
NPI:1184711368
Name:HARTSOOK, LAUREEN A
Entity type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:A
Last Name:HARTSOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:PINE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91962-0333
Mailing Address - Country:US
Mailing Address - Phone:619-473-9017
Mailing Address - Fax:
Practice Address - Street 1:9745 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6209
Practice Address - Country:US
Practice Address - Phone:619-449-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2304225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant