Provider Demographics
NPI:1245657428
Name:HARDY, RENISHA
Entity type:Individual
Prefix:
First Name:RENISHA
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 1:206 MARINA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-7058
Mailing Address - Country:US
Mailing Address - Phone:443-857-1353
Mailing Address - Fax:443-348-5970
Practice Address - Street 1:1718 BELMONT AVE STE C
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2552
Practice Address - Country:US
Practice Address - Phone:443-200-5294
Practice Address - Fax:443-348-5970
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist