Provider Demographics
NPI:1700186962
Name:HART, JONATHAN BRADLEY (LPTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BRADLEY
Last Name:HART
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:MC ARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651-0055
Mailing Address - Country:US
Mailing Address - Phone:740-577-8353
Mailing Address - Fax:
Practice Address - Street 1:16 E WOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1238
Practice Address - Country:US
Practice Address - Phone:740-577-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5697225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant