Provider Demographics
NPI:1538318803
Name:JOLLEY, TONYA (PTA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:JOLLEY
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 1:707 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-208-8989
Mailing Address - Fax:870-208-8107
Practice Address - Street 1:707 ELDRIDGE AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4032
Practice Address - Country:US
Practice Address - Phone:870-208-8989
Practice Address - Fax:870-208-8107
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2266225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant