Provider Demographics
NPI:1962078774
Name:HARDEE, MACEY FAITH
Entity type:Individual
Prefix:MISS
First Name:MACEY
Middle Name:FAITH
Last Name:HARDEE
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 1:1104 NW 265TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTEY
Mailing Address - State:FL
Mailing Address - Zip Code:32058
Mailing Address - Country:US
Mailing Address - Phone:904-769-0564
Mailing Address - Fax:
Practice Address - Street 1:1104 NW 265TH ST
Practice Address - Street 2:
Practice Address - City:LAWTEY
Practice Address - State:FL
Practice Address - Zip Code:32058
Practice Address - Country:US
Practice Address - Phone:904-769-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30858225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant