Provider Demographics
NPI:1295741353
Name:HART, DEIDRE B (MSPT)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:B
Last Name:HART
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147B WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4013
Mailing Address - Country:US
Mailing Address - Phone:508-991-2918
Mailing Address - Fax:508-994-3068
Practice Address - Street 1:147B WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4013
Practice Address - Country:US
Practice Address - Phone:508-991-2918
Practice Address - Fax:508-994-3068
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69022Medicare ID - Type Unspecified