Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0000004548 | TN |
NPI | 1003222639 |
---|---|
Provider Name | Keyna Hart |
First Address | Greenbrier, TN 37073-5268 |
Second Address | Springfield, TN 37172-4801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 02/07/2014 |