Provider Demographics
NPI:1609897917
Name:HYATT, JACINDA DENISE (PT)
Entity type:Individual
Prefix:MRS
First Name:JACINDA
Middle Name:DENISE
Last Name:HYATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JACINDA
Other - Middle Name:DENISE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:10508 CASTLETON
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908
Mailing Address - Country:US
Mailing Address - Phone:479-649-9441
Mailing Address - Fax:479-649-9441
Practice Address - Street 1:4505 NORTH RUDY ROAD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956
Practice Address - Country:US
Practice Address - Phone:479-414-9793
Practice Address - Fax:479-474-4044
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist