Individual
HAZEL LEANN GOINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2502 FAYETTEVILLE RD, VAN BUREN, AR 72956-6073
(479) 410-1900
(479) 410-1063
Mailing address
2502 FAYETTEVILLE RD, VAN BUREN, AR 72956-6073
(479) 410-1900
(479) 410-1063
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1275
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140658721
—
AR
Enumeration date
01/29/2018
Last updated
01/29/2018
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