Healthcare Provider Details

I. General information

NPI: 1730521287
Provider Name (Legal Business Name): CHRISTI JO BETH P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SOUTHPARK SHOPPING CTR
NASHVILLE AR
71852-3307
US

IV. Provider business mailing address

22 SOUTHPARK SHOPPING CTR
NASHVILLE AR
71852-3307
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-5600
  • Fax: 870-845-5604
Mailing address:
  • Phone: 870-845-5600
  • Fax: 870-845-5604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2740
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: