Provider Demographics
NPI:1114148566
Name:HARTY, RICHARD GREGORY (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GREGORY
Last Name:HARTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 CHAPARRAL CT
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4100
Mailing Address - Country:US
Mailing Address - Phone:209-369-7224
Mailing Address - Fax:
Practice Address - Street 1:7829 N PERSHING AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-1749
Practice Address - Country:US
Practice Address - Phone:209-406-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist