Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1607 | AR |
NPI | 1013165265 |
---|---|
Provider Name | Ms. Vicki Leann Hurst |
First Address | Springdale, AR 72762-2829 |
Second Address | Springdale, AR 72762-2829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 29/08/2008 |