Provider Demographics
NPI:1518226620
Name:HARDIN, MARK ALAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 EASTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-8034
Mailing Address - Country:US
Mailing Address - Phone:336-824-3155
Mailing Address - Fax:
Practice Address - Street 1:106 MOUNT VISTA RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239-8793
Practice Address - Country:US
Practice Address - Phone:336-859-0773
Practice Address - Fax:336-859-0773
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4153225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant