Provider Demographics
NPI:1083616536
Name:HART PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:HART PHYSICAL THERAPY INC
Other - Org Name:HANSEN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-342-3110
Mailing Address - Street 1:50 MINNESOTA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6217
Mailing Address - Country:US
Mailing Address - Phone:605-342-3110
Mailing Address - Fax:605-342-3120
Practice Address - Street 1:50 MINNESOTA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6217
Practice Address - Country:US
Practice Address - Phone:605-342-3110
Practice Address - Fax:605-342-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS42097Medicare PIN