Provider Demographics
NPI:1689900805
Name:CAGLE, MISTY N (MS, PT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:N
Last Name:CAGLE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 INNSBROOKE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3678
Mailing Address - Country:US
Mailing Address - Phone:501-985-2235
Mailing Address - Fax:
Practice Address - Street 1:119 W H AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8733
Practice Address - Country:US
Practice Address - Phone:501-772-3224
Practice Address - Fax:501-771-7648
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist