Individual
LACIE BETTENCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
201 N COLLEGE ST, MOUNTAIN HOME, AR 72653-3653
(807) 404-5299
Mailing address
PO BOX 2398, MOUNTAIN HOME, AR 72654-2398
(870) 404-5299
(870) 404-5299
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2392
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2392
PTA LICENSE #
AK
Enumeration date
04/03/2012
Last updated
03/10/2025
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