Provider Demographics
NPI:1770175697
Name:HART, CAROLINE PUALANI (DPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PUALANI
Last Name:HART
Suffix:
Gender:F
Credentials:DPT
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 561564
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-6023
Mailing Address - Country:US
Mailing Address - Phone:702-478-9594
Mailing Address - Fax:
Practice Address - Street 1:2770 S MARYLAND PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1554
Practice Address - Country:US
Practice Address - Phone:702-478-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist