Provider Demographics
NPI:1669916409
Name:HART, KELLY (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
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 1:4217 MERRYBELLS CT
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1064
Mailing Address - Country:US
Mailing Address - Phone:610-401-4990
Mailing Address - Fax:
Practice Address - Street 1:4217 MERRYBELLS CT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-1064
Practice Address - Country:US
Practice Address - Phone:610-401-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist