Healthcare Provider Details

I. General information

NPI: 1629553904
Provider Name (Legal Business Name): ELIZABETH RHOADS HAYNIE CCC-SLP, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CLAIRE RHOADS PTA

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 S 12TH ST
ROGERS AR
72758-6307
US

IV. Provider business mailing address

48 W COLT SQUARE DR
FAYETTEVILLE AR
72703-2813
US

V. Phone/Fax

Practice location:
  • Phone: 479-877-1794
  • Fax:
Mailing address:
  • Phone: 479-582-2740
  • Fax: 479-582-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4392
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number202601
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: