Healthcare Provider Details

I. General information

NPI: 1104095462
Provider Name (Legal Business Name): HADLEY PEDIATRIC PHYSICAL THERAPY, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 FOX MEADOW LN
JONESBORO AR
72404-9346
US

IV. Provider business mailing address

4010 BRANDYWINE DR
JONESBORO AR
72404-0720
US

V. Phone/Fax

Practice location:
  • Phone: 870-530-3693
  • Fax: 870-933-9293
Mailing address:
  • Phone: 870-530-3693
  • Fax: 870-933-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT2722
License Number StateAR

VIII. Authorized Official

Name: ALICIA PHILLIPS HADLEY
Title or Position: OWNER
Credential: P.T., D.P.T.
Phone: 870-530-3693