Provider Demographics
NPI:1447634001
Name:HAMBRICK PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HAMBRICK PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVENA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAMBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:870-307-4226
Mailing Address - Street 1:270 SOUTHFORK 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:870-307-4226
Mailing Address - Fax:
Practice Address - Street 1:270 SOUTHFORK 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:870-307-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1861672586OtherINDIVIDUAL NPI
AR166282721Medicaid