MEDICARE: MRS. JACINDA DENISE HYATT PT

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	225100000X	Physical Therapist	817	AR

General Provider Information

NPI Number	:	1609897917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACINDA DENISE HYATT PT

Provider Business Mailing Address
First Line	:	10508 CASTLETON
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908
Country	:	US
Telephone Number	:	479-649-9441
Fax Number	:	479-649-9441

Provider Business Practice Location Address
First Line	:	4505 NORTH RUDY ROAD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956
Country	:	US
Telephone Number	:	479-414-9793
Fax Number	:	479-474-4044

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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