Provider Demographics
NPI:1902384621
Name:HARDER, BRIAN J (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:HARDER
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 MARKET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-4465
Mailing Address - Country:US
Mailing Address - Phone:423-362-4381
Mailing Address - Fax:
Practice Address - Street 1:7550 E BRAINERD RD STE 121
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3189
Practice Address - Country:US
Practice Address - Phone:423-842-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist