Healthcare Provider Details

I. General information

NPI: 1821860784
Provider Name (Legal Business Name): HRT PA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 LIMEKILN PIKE
DRESHER PA
19025-1053
US

IV. Provider business mailing address

1615 LIMEKILN PIKE
DRESHER PA
19025-1053
US

V. Phone/Fax

Practice location:
  • Phone: 267-201-8162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TEAH MICHELLE SMITH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 901-205-3999