Healthcare Provider Details

I. General information

NPI: 1912616145
Provider Name (Legal Business Name): HRT PA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 MIDDLETOWN BLVD STE B22
LANGHORNE PA
19047-1879
US

IV. Provider business mailing address

582 MIDDLETOWN BLVD STE B22
LANGHORNE PA
19047-1879
US

V. Phone/Fax

Practice location:
  • Phone: 267-201-8162
  • Fax:
Mailing address:
  • Phone: 267-201-8162
  • 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 SMITH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 901-205-3999