Provider Demographics
NPI:1235358631
Name:HYATT, MARGIE (PTA)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-1114
Mailing Address - Country:US
Mailing Address - Phone:479-675-2630
Mailing Address - Fax:
Practice Address - Street 1:1919 CHARMONT DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933
Practice Address - Country:US
Practice Address - Phone:479-965-2612
Practice Address - Fax:479-965-2612
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 1347225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant