MEDICARE: PATRICIA ANN HART PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	9985	CA

General Provider Information

NPI Number	:	1053715102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN HART PTA

Provider Business Mailing Address
First Line	:	2524 CARLSON BLVD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-5708
Country	:	US
Telephone Number	:	916-606-3764
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 CARLSON BLVD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-5708
Country	:	US
Telephone Number	:	916-606-3764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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