Healthcare Provider Details

I. General information

NPI: 1063674638
Provider Name (Legal Business Name): PATRICIA HA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 REMINGTON CIR
FORT SMITH AR
72903-6523
US

IV. Provider business mailing address

5905 REMINGTON CIR
FORT SMITH AR
72903-6523
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-7773
  • Fax: 479-452-7774
Mailing address:
  • Phone: 479-452-7773
  • Fax: 479-452-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3800
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: