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General NPI Number Information
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NPI Number | 1841143492
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Entity Type | Individual
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Provider Name | HAYLEY JORDAN BLACKWOOD PTA
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Gender | Female
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 201 S 7TH ST
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-3718
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Country | US
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Telephone | 501-691-3957
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Fax |
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Provider Business Mailing Address
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Address Line | 295 SKYLINE DR
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-9000
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Country | US
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Telephone | 501-691-3957
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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 | 3985
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License Number State | AR
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