Provider Demographics
NPI:1538667266
Name:HOGARD, SAMANTHA (PTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HOGARD
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 1:5552 US HWY63
Mailing Address - Street 2:SUITE B
Mailing Address - City:IMBODEN
Mailing Address - State:AR
Mailing Address - Zip Code:72434
Mailing Address - Country:US
Mailing Address - Phone:870-869-7221
Mailing Address - Fax:
Practice Address - Street 1:5552 US HWY 63
Practice Address - Street 2:SUITE B
Practice Address - City:IMBODEN
Practice Address - State:AR
Practice Address - Zip Code:72434
Practice Address - Country:US
Practice Address - Phone:870-869-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2328225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant