Healthcare Provider Details

I. General information

NPI: 1235563545
Provider Name (Legal Business Name): CHRISTINA WARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 COUNTY ROAD 25
MOUNTAIN HOME AR
72653-7624
US

IV. Provider business mailing address

PO BOX 24
LEAD HILL AR
72644-0024
US

V. Phone/Fax

Practice location:
  • Phone: 870-321-0827
  • Fax:
Mailing address:
  • Phone: 870-321-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1745
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: