Provider Demographics
NPI:1861672586
Name:HAMBRICK, LAVENA ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LAVENA
Middle Name:ANN
Last Name:HAMBRICK
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 1:270 SOUTH FORK RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7791
Mailing Address - Country:US
Mailing Address - Phone:870-251-2010
Mailing Address - Fax:
Practice Address - Street 1:270 SOUTH FORK RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7791
Practice Address - Country:US
Practice Address - Phone:870-251-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant