Provider Demographics
NPI:1730384249
Name:HART, MEREDITH LISSA
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:LISSA
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 RIVERBANK ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2674
Mailing Address - Country:US
Mailing Address - Phone:734-284-1445
Mailing Address - Fax:
Practice Address - Street 1:717 RIVERBANK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2674
Practice Address - Country:US
Practice Address - Phone:734-284-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant