Provider Demographics
NPI:1114001807
Name:HART, LORI ANN (DPT)
Entity Type:Individual
Prefix:MISS
First Name:LORI
Middle Name:ANN
Last Name:HART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PORTERS NECK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9196
Mailing Address - Country:US
Mailing Address - Phone:910-686-5604
Mailing Address - Fax:910-892-0029
Practice Address - Street 1:1011 PORTERS NECK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9196
Practice Address - Country:US
Practice Address - Phone:910-686-6506
Practice Address - Fax:910-892-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211634Medicaid
346639Medicare ID - Type Unspecified