Provider Demographics
NPI:1346453115
Name:HART, ANNETTE M (PT)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 N NASH ST
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944
Mailing Address - Country:US
Mailing Address - Phone:920-779-0285
Mailing Address - Fax:
Practice Address - Street 1:725 BUTLER AVE
Practice Address - Street 2:PARKVIEW HEALTH CARE CENTER
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0010
Practice Address - Country:US
Practice Address - Phone:920-235-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1566 024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI401653Medicaid