Provider Demographics
NPI:1760141931
Name:HART, ANDREA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 N MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-2003
Mailing Address - Country:US
Mailing Address - Phone:360-355-5715
Mailing Address - Fax:
Practice Address - Street 1:13055 W MCDOWELL RD STE G107
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6450
Practice Address - Country:US
Practice Address - Phone:623-547-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist