Provider Demographics
NPI:1932183605
Name:HART, SALLY A (CMF)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:A
Last Name:HART
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W BARNWELL ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5390
Mailing Address - Country:US
Mailing Address - Phone:828-698-0734
Mailing Address - Fax:828-698-0735
Practice Address - Street 1:121 W BARNWELL ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5390
Practice Address - Country:US
Practice Address - Phone:828-698-0734
Practice Address - Fax:828-698-0735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2096800001Medicare ID - Type Unspecified