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General NPI Number Information
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NPI Number | 1811228828
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Entity Type | Individual
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Provider Name | ERIC DANIEL HUTSELL PTA
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Gender | Male
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 6026 CRESCENT ACRES LN
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City | VAN BUREN
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State | AR
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Zip | 72956-8467
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Country | US
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Telephone | 479-629-5346
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Fax |
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Provider Business Mailing Address
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Address Line | 6026 CRESCENT ACRES LN
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City | VAN BUREN
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State | AR
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Zip | 72956-8467
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2368
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2074380
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License Number State | TX
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