Provider Demographics
NPI:1912574666
Name:HARDY, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5882
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0223
Mailing Address - Country:US
Mailing Address - Phone:972-217-4664
Mailing Address - Fax:214-618-8799
Practice Address - Street 1:7920 PRESTON RD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2348
Practice Address - Country:US
Practice Address - Phone:214-293-6995
Practice Address - Fax:972-249-2065
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies