Healthcare Provider Details

I. General information

NPI: 1235303397
Provider Name (Legal Business Name): ELLEN DENISE HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156A SEASHORE PT
HOT SPRINGS AR
71913-8692
US

IV. Provider business mailing address

156A SEASHORE PT
HOT SPRINGS AR
71913-8692
US

V. Phone/Fax

Practice location:
  • Phone: 870-703-8589
  • Fax:
Mailing address:
  • Phone: 870-703-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2049
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2061257
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2049
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: