Healthcare Provider Details

I. General information

NPI: 1437387909
Provider Name (Legal Business Name): KATIE REBECCA HORNBEAK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 HIGHWAY 64B
WYNNE AR
72396-8506
US

IV. Provider business mailing address

205 MCCUTCHEN ST
FORREST CITY AR
72335-3435
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-7038
  • Fax:
Mailing address:
  • Phone: 870-261-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2330
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: