Provider Demographics
NPI:1861748337
Name:HARDESTY, KURT (LMP)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 NE 110TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6736
Mailing Address - Country:US
Mailing Address - Phone:513-309-8358
Mailing Address - Fax:
Practice Address - Street 1:2521 NE 110TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6736
Practice Address - Country:US
Practice Address - Phone:513-309-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist