Healthcare Provider Details

I. General information

NPI: 1396097101
Provider Name (Legal Business Name): MARY K HART RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

317 LEXINGTON AVE APT 247
SAN ANTONIO TX
78215-1916
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-7963
  • Fax:
Mailing address:
  • Phone: 214-718-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number50419
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: