Basic Information
| Provider Information | |||||||||
| NPI: | 1902384621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1463 MARKET ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374024465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233624381 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7550 E BRAINERD RD STE 121 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238429322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2018 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14352 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.