Provider Demographics
NPI:1689189342
Name:HART, ABBY NADINE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:NADINE
Last Name:HART
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COLORADO AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1592
Mailing Address - Country:US
Mailing Address - Phone:719-468-9056
Mailing Address - Fax:
Practice Address - Street 1:201 COLORADO AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1592
Practice Address - Country:US
Practice Address - Phone:719-468-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0020444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty