Provider Demographics
NPI:1518345917
Name:HART, DEVIN (MSC, ATC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:MSC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1240
Mailing Address - Country:US
Mailing Address - Phone:719-569-0237
Mailing Address - Fax:
Practice Address - Street 1:2900 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1240
Practice Address - Country:US
Practice Address - Phone:719-569-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00012072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer