Provider Demographics
NPI:1073301958
Name:HART, KINDRA (PTA, BS)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:
Last Name:HART
Suffix:
Gender:
Credentials:PTA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 COUNTY ROAD 4614
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-8001
Mailing Address - Country:US
Mailing Address - Phone:518-744-1032
Mailing Address - Fax:
Practice Address - Street 1:2055 W GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0526
Practice Address - Country:US
Practice Address - Phone:903-534-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2124763225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant