Provider Demographics
NPI:1043427842
Name:HART, IRA J (ATC)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:J
Last Name:HART
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:8915 SILVER LAKE DR
Mailing Address - Street 2:APT. 5
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3423
Mailing Address - Country:US
Mailing Address - Phone:352-497-7486
Mailing Address - Fax:
Practice Address - Street 1:9501 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3950
Practice Address - Country:US
Practice Address - Phone:352-435-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL17282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer