Individual
INA RAE BROADAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1801 CHAMPLIN DR, APT. 1206, LITTLE ROCK, AR 72223-3965
(870) 758-0154
Mailing address
1801 CHAMPLIN DR, APT. 1206, LITTLE ROCK, AR 72223-3965
(870) 758-0154
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 804
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148454721
—
AR
Enumeration date
03/11/2011
Last updated
03/11/2011
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