Provider Demographics
NPI:1134475924
Name:HARDY, LENA S (PT)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:S
Last Name:HARDY
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 1:104 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-2617
Mailing Address - Country:US
Mailing Address - Phone:251-321-0799
Mailing Address - Fax:251-321-0798
Practice Address - Street 1:104 5TH AVE
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-2617
Practice Address - Country:US
Practice Address - Phone:251-321-0799
Practice Address - Fax:251-321-0798
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherGROUP NPI
AL529917620Medicaid
ALK531Medicare UPIN