Provider Demographics
NPI:1831380328
Name:BASTIN, JONI M (PT)
Entity type:Individual
Prefix:MS
First Name:JONI
Middle Name:M
Last Name:BASTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JONI
Other - Middle Name:L
Other - Last Name:HEFFRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2078
Mailing Address - Country:US
Mailing Address - Phone:479-856-2504
Mailing Address - Fax:
Practice Address - Street 1:515 N 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-2015
Practice Address - Country:US
Practice Address - Phone:479-856-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist