Provider Demographics
NPI:1043234891
Name:HARDY, MARY LEE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:LEE
Last Name:HARDY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-4321
Mailing Address - Country:US
Mailing Address - Phone:801-933-5113
Mailing Address - Fax:
Practice Address - Street 1:345 E 4500 S
Practice Address - Street 2:SUITE 120
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3991
Practice Address - Country:US
Practice Address - Phone:801-268-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT350595-4701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist