Provider Demographics
NPI:1609185396
Name:HART, JAYNE M (DPT)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 HIGHWAY 96 W STE 200
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2118
Mailing Address - Country:US
Mailing Address - Phone:651-766-0080
Mailing Address - Fax:
Practice Address - Street 1:490 HIGHWAY 96 W STE 200
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2118
Practice Address - Country:US
Practice Address - Phone:651-766-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist