Provider Demographics
NPI:1184681504
Name:HADLEY, ALICIA (DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-0720
Mailing Address - Country:US
Mailing Address - Phone:870-530-3693
Mailing Address - Fax:870-933-9293
Practice Address - Street 1:4010 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-0720
Practice Address - Country:US
Practice Address - Phone:870-530-3693
Practice Address - Fax:870-933-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2722174400000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X844OtherBLUECROSS PROVIDER #