Provider Demographics
NPI:1174756308
Name:HART, ANN M (MS,PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 N BRIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2036
Mailing Address - Country:US
Mailing Address - Phone:815-459-6395
Mailing Address - Fax:815-459-6608
Practice Address - Street 1:965 N BRIGHTON CIR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2036
Practice Address - Country:US
Practice Address - Phone:815-459-6395
Practice Address - Fax:815-459-6608
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist