Individual
MARIA JESTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1001 S MAIN ST, MOUNTAIN HOME, AR 72653-4763
(870) 421-8189
Mailing address
64 COUNTY ROAD 461, MOUNTAIN HOME, AR 72653-7634
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4647
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4647
LICENSE PTA
AR
Enumeration date
08/02/2022
Last updated
08/02/2022
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