Provider Demographics
NPI:1841703691
Name:HARDY, JONATHAN DAVID (PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:HARDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W IRIS DR SE APT B1104
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1912
Mailing Address - Country:US
Mailing Address - Phone:256-496-4955
Mailing Address - Fax:
Practice Address - Street 1:1315 MILSTEAD RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3824
Practice Address - Country:US
Practice Address - Phone:470-545-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10496225100000X
2255A2300X
GAPT016761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer