Basic Information
| Provider Information | |||||||||
| NPI: | 1124766795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | ATC, PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 EQUESTRIAN LAKES LN | ||||||||
| Address2: | |||||||||
| City: | FINCHVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400224704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735218251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4121 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402073205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028931380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2022 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.