Provider Demographics
NPI:1831690494
Name:HARDWICK, LAURA ANN (PTA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HARDWICK
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 1:901 SE 28TH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3890
Mailing Address - Country:US
Mailing Address - Phone:479-402-9400
Mailing Address - Fax:
Practice Address - Street 1:901 SE 28TH ST STE 11
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3890
Practice Address - Country:US
Practice Address - Phone:479-402-9400
Practice Address - Fax:479-308-0223
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4208225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant