Provider Demographics
NPI:1649878190
Name:HEFTY, JOSHUA CHRISTIAN
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CHRISTIAN
Last Name:HEFTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14255 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72732-9342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 FOREST BLVD #205
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4579225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant