Provider Demographics
NPI:1376967190
Name:NEWTON, HANNA MARISSA (PTA)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:MARISSA
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:HANNA
Other - Middle Name:MARISSA
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:6416 THE DIVIDE PKWY
Mailing Address - Street 2:APT 103
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5871
Mailing Address - Country:US
Mailing Address - Phone:870-918-8947
Mailing Address - Fax:
Practice Address - Street 1:2615 N PRICKETT RD
Practice Address - Street 2:#10
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7523
Practice Address - Country:US
Practice Address - Phone:501-847-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2419225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant