Provider Demographics
NPI:1740429620
Name:HAUSMAN, MEGAN SUZANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:SUZANNE
Last Name:HAUSMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:AR
Mailing Address - Zip Code:72433-2419
Mailing Address - Country:US
Mailing Address - Phone:870-897-9104
Mailing Address - Fax:
Practice Address - Street 1:1600 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-2419
Practice Address - Country:US
Practice Address - Phone:870-679-1506
Practice Address - Fax:870-679-1507
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175787721Medicaid