Individual
BONNIE HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
45 MALLETT DR, FREEPORT, ME 04032-1312
(207) 442-0325
(207) 443-4578
Mailing address
45 MALLETT DR, FREEPORT, ME 04032-1312
(207) 442-0325
(207) 443-4578
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3542
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952485765
ANTHEM
—
05
—
434335099
—
ME
Enumeration date
06/22/2009
Last updated
02/22/2012
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