Provider Demographics
NPI:1790044279
Name:HART, JEFFREY DALE (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DALE
Last Name:HART
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19016 STONE OAK PKWY
Mailing Address - Street 2:STE. 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3280
Mailing Address - Country:US
Mailing Address - Phone:210-545-5111
Mailing Address - Fax:210-545-5120
Practice Address - Street 1:19016 STONE OAK PKWY
Practice Address - Street 2:STE. 280
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3280
Practice Address - Country:US
Practice Address - Phone:210-545-5111
Practice Address - Fax:210-545-5120
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist