Provider Demographics
NPI:1790152726
Name:HART, HOLLY J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
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 1:13818 BENT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1595
Mailing Address - Country:US
Mailing Address - Phone:832-287-6897
Mailing Address - Fax:
Practice Address - Street 1:18600 HARDY OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4206
Practice Address - Country:US
Practice Address - Phone:210-404-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261647261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy