Individual
BRADEN TEWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
400 W 23RD ST, HOPE, AR 71801
(870) 777-3448
Mailing address
800 HEMPSTEAD 36, HOPE, AR 71801-9048
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3958
AR
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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