Provider Demographics
NPI:1891151197
Name:HART, JOSEPH M III (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:HART
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EMMET ST S
Mailing Address - Street 2:BOX 400407
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2455
Mailing Address - Country:US
Mailing Address - Phone:434-924-6187
Mailing Address - Fax:
Practice Address - Street 1:210 EMMET ST S
Practice Address - Street 2:BOX 400407
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2455
Practice Address - Country:US
Practice Address - Phone:434-924-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260003312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126000331OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS LICENSE
079702460OtherNATABOC CERTIFICATION NUMBER