Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003059320 |
---|---|
Provider Name | Brent A. Hart |
First Address | Lynwood, CA 90262-4284 |
Second Address | Lynwood, CA 90262-4284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2009 |
Last Update Date | 16/04/2009 |