Individual
ELLEN R HAVERSTICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1065 CLAYTON ST, SUITE 9, CONWAY, AR 72032-4329
(501) 328-5878
(501) 336-0119
Mailing address
PO BOX 1168, CONWAY, AR 72033-1168
(501) 733-3969
(501) 336-0119
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2484
AR
Other
Enumeration date
06/10/2006
Last updated
09/10/2024
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