Provider Demographics
NPI:1629526306
Name:HART, RICHARD H (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:HART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1148
Mailing Address - Country:US
Mailing Address - Phone:207-647-6145
Mailing Address - Fax:207-647-6065
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1148
Practice Address - Country:US
Practice Address - Phone:207-647-6145
Practice Address - Fax:207-647-6065
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist