MEDICARE: MRS. JENNETTE LEE HILES LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA1513	AR

General Provider Information

NPI Number	:	1558679761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNETTE LEE HILES LPTA

Provider Business Mailing Address
First Line	:	265 COOK LANE
Second Line	:
City	:	WIDEMAN
State	:	AR
Zip	:	72585-0265
Country	:	US
Telephone Number	:	870-404-4329
Fax Number	:	870-297-8468

Provider Business Practice Location Address
First Line	:	2161 AR 56 HWY
Second Line	:
City	:	CALICO ROCK
State	:	AR
Zip	:	72519-7009
Country	:	US
Telephone Number	:	870-404-4329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	11/02/2023

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