Healthcare Provider Details

I. General information

NPI: 1134687148
Provider Name (Legal Business Name): PATRICIA ANN HURST PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAIN ST
GREEN FOREST AR
72638
US

IV. Provider business mailing address

10914 CRICKET CUTOFF
OMAHA AR
72662-9375
US

V. Phone/Fax

Practice location:
  • Phone: 479-253-1815
  • Fax: 870-533-5533
Mailing address:
  • Phone: 870-391-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2092
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: