Provider Demographics
NPI:1972787729
Name:HART PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HART PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICALTHERAPIST OPERATINGMANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GERLOCK
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:941-706-4447
Mailing Address - Street 1:3385 MAGIC OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1821
Mailing Address - Country:US
Mailing Address - Phone:941-706-4447
Mailing Address - Fax:
Practice Address - Street 1:3385 MAGIC OAK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1821
Practice Address - Country:US
Practice Address - Phone:941-706-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAO725Medicare PIN