Provider Demographics
NPI:1053407502
Name:HARTIGAN, JAY R (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:R
Last Name:HARTIGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18165 125TH AVE. NORTH
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478
Mailing Address - Country:US
Mailing Address - Phone:561-707-6296
Mailing Address - Fax:561-575-5259
Practice Address - Street 1:11380 PROSPERITY FARMS RD. STE. B109
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-803-7761
Practice Address - Fax:561-803-7762
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4732ZMedicare ID - Type Unspecified