Healthcare Provider Details

I. General information

NPI: 1477365591
Provider Name (Legal Business Name): CORTNI PAIGE HULETT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 SOUTHWEST DRIVE
JONESBORO AR
72404
US

IV. Provider business mailing address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-2090
  • Fax: 870-974-5083
Mailing address:
  • Phone: 870-207-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5580
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: