Provider Demographics
NPI:1538639265
Name:HERRING, SONDRA (PTA)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:HERRING
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 1:400 E HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-6514
Mailing Address - Country:US
Mailing Address - Phone:870-204-5019
Mailing Address - Fax:
Practice Address - Street 1:400 E HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-6514
Practice Address - Country:US
Practice Address - Phone:870-204-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
AR2114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant