Individual
MR. KENNETH DAVID HART JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
410 N STATE OF FRANKLIN RD STE 140, JOHNSON CITY, TN 37604-6972
(423) 431-2460
(423) 431-2465
Mailing address
340 LOWE RD, PINEY FLATS, TN 37686-3728
(423) 217-5631
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
—
—
2255A2300X
Athletic Trainer
Primary
AT0000000761
TN
Other
Enumeration date
11/18/2022
Last updated
11/18/2022
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