Provider Demographics
NPI:1891599288
Name:HART, BRENNA ELISE
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:ELISE
Last Name:HART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10375 RUTLEDGE RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4358
Mailing Address - Country:US
Mailing Address - Phone:704-298-8151
Mailing Address - Fax:
Practice Address - Street 1:150 FAIRVIEW RD STE 230
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9508
Practice Address - Country:US
Practice Address - Phone:704-323-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist