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General NPI Number Information
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NPI Number | 1891599288
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Entity Type | Individual
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Provider Name | BRENNA ELISE HART
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Gender | Female
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 150 FAIRVIEW RD STE 230
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City | MOORESVILLE
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State | NC
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Zip | 28117-9508
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Country | US
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Telephone | 704-323-2921
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Fax |
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Provider Business Mailing Address
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Address Line | 10375 RUTLEDGE RIDGE DR NW
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-4358
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Country | US
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Telephone | 704-298-8151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | A8215
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License Number State | NC
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