Provider Demographics
NPI:1619100583
Name:HART, GARRY T (LMT)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:T
Last Name:HART
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17624 MERIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-5858
Mailing Address - Country:US
Mailing Address - Phone:727-992-3906
Mailing Address - Fax:
Practice Address - Street 1:17624 MERIDIAN BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-5858
Practice Address - Country:US
Practice Address - Phone:727-992-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 54739175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath