Provider Demographics
NPI:1649002247
Name:HARDGRAVE, AMBER (PTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HARDGRAVE
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 1:2896 HIGHWAY 359
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:AR
Mailing Address - Zip Code:72846
Mailing Address - Country:US
Mailing Address - Phone:479-979-4895
Mailing Address - Fax:
Practice Address - Street 1:2621 W MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2551
Practice Address - Country:US
Practice Address - Phone:479-567-5362
Practice Address - Fax:479-567-5447
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant