Provider Demographics
NPI:1437387909
Name:HORNBEAK, KATIE REBECCA (PTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:REBECCA
Last Name:HORNBEAK
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 1:205 MCCUTCHEN ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3435
Mailing Address - Country:US
Mailing Address - Phone:870-261-5764
Mailing Address - Fax:
Practice Address - Street 1:661 HIGHWAY 64B
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-8506
Practice Address - Country:US
Practice Address - Phone:870-238-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2330225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant