Provider Demographics
NPI:1134687148
Name:HURST, PATRICIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HURST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 CRICKET CUTOFF
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:AR
Mailing Address - Zip Code:72662-9375
Mailing Address - Country:US
Mailing Address - Phone:870-391-9894
Mailing Address - Fax:
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN FOREST
Practice Address - State:AR
Practice Address - Zip Code:72638
Practice Address - Country:US
Practice Address - Phone:479-253-1815
Practice Address - Fax:870-533-5533
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist