Healthcare Provider Details

I. General information

NPI: 1215859632
Provider Name (Legal Business Name): VERNON HART JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 KNICKERBOCKER RD.
SAN ANGELO TX
76904
US

IV. Provider business mailing address

5702 MELROSE AVE LOT F38
SAN ANGELO TX
76901-5338
US

V. Phone/Fax

Practice location:
  • Phone: 325-947-3838
  • Fax:
Mailing address:
  • Phone: 325-947-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT10492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: