Provider Demographics
NPI:1235119694
Name:HILL, GARY WADE (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WADE
Last Name:HILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W COLLEGE AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-3142
Mailing Address - Country:US
Mailing Address - Phone:870-423-3316
Mailing Address - Fax:870-423-3177
Practice Address - Street 1:402 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-3142
Practice Address - Country:US
Practice Address - Phone:870-423-3316
Practice Address - Fax:870-423-3177
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR608639900OtherUSDA
WA0197288OtherDEPT LABOR & INDUSTRY
AR154774721Medicaid
AR5Y014OtherBLUECROSS
AR729459559OtherTRICARE
AR154774721Medicaid
AR731715179OtherEIN
WA0197288OtherDEPT LABOR & INDUSTRY