Provider Demographics
NPI:1780654764
Name:DEBORAH ASHWORTH PA
Entity Type:Organization
Organization Name:DEBORAH ASHWORTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ASHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-651-3389
Mailing Address - Street 1:4505 N RUDY RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-9062
Mailing Address - Country:US
Mailing Address - Phone:479-474-4011
Mailing Address - Fax:479-474-4044
Practice Address - Street 1:1036 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-6807
Practice Address - Country:US
Practice Address - Phone:479-651-3389
Practice Address - Fax:479-474-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR806225100000X
OK2133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155820716Medicaid
AR127239742Medicaid