Provider Demographics
NPI:1447853643
Name:HART, JOANNE ANNETTE (PTA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:ANNETTE
Last Name:HART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 FLORIDA 77
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444
Mailing Address - Country:US
Mailing Address - Phone:850-252-1414
Mailing Address - Fax:
Practice Address - Street 1:2211 FLORIDA S HIGHWAY 77
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4640
Practice Address - Country:US
Practice Address - Phone:850-252-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28421225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant