Provider Demographics
NPI:1093359648
Name:HART, KAREN ALICIA (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ALICIA
Last Name:HART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301A HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2829
Mailing Address - Country:US
Mailing Address - Phone:601-250-5455
Mailing Address - Fax:601-250-5453
Practice Address - Street 1:1301A HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2829
Practice Address - Country:US
Practice Address - Phone:601-250-5455
Practice Address - Fax:601-250-5453
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist