Basic Information
Provider Information
NPI: 1619927274
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARGUS
FirstName: HEMA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 809 FARSON ST
Address2: SUITE 105
City: BELPRE
State: OH
PostalCode: 457141066
CountryCode: US
TelephoneNumber: 7404231507
FaxNumber: 7404010660
Practice Location
Address1: 1500 GRAND CENTRAL AVE
Address2: SUITE 101
City: VIENNA
State: WV
PostalCode: 261051079
CountryCode: US
TelephoneNumber: 3042953060
FaxNumber: 3042953065
Other Information
ProviderEnumerationDate: 05/12/2006
LastUpdateDate: 01/13/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X000881WVY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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