Healthcare Provider Details

I. General information

NPI: 1932899333
Provider Name (Legal Business Name): GARY HARDT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

5926 56TH AVE S
FARGO ND
58104-5697
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8900
  • Fax:
Mailing address:
  • Phone: 701-541-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number194536
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: