Provider Demographics
NPI:1558679761
Name:HILES, JENNETTE LEE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNETTE
Middle Name:LEE
Last Name:HILES
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 COOK LANE
Mailing Address - Street 2:
Mailing Address - City:WIDEMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72585-0265
Mailing Address - Country:US
Mailing Address - Phone:870-404-4329
Mailing Address - Fax:870-297-8468
Practice Address - Street 1:2161 AR 56 HWY
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-7009
Practice Address - Country:US
Practice Address - Phone:870-404-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant