Provider Demographics
NPI:1396912226
Name:HART, ALEXANDER F (PT, DPT, FAFS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:F
Last Name:HART
Suffix:
Gender:M
Credentials:PT, DPT, FAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MAIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1306
Mailing Address - Country:US
Mailing Address - Phone:920-403-0085
Mailing Address - Fax:
Practice Address - Street 1:920 MAIN AVE STE B
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1306
Practice Address - Country:US
Practice Address - Phone:920-403-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1253850225100000X
KY007322225100000X
WA60582266225100000X
MN10215225100000X
MD28299225100000X
WI14909-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2049098Medicaid