Individual
MRS. MYRA HIZOLA CAANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
300 WAVERLY CV, JONESBORO, AR 72404-9490
(870) 740-2175
Mailing address
300 WAVERLY CV, JONESBORO, AR 72404-9490
(870) 740-2175
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2605
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146510721
—
AR
01
—
5W948
BCBS INDIV. PROVIDER #
AR
Enumeration date
04/14/2006
Last updated
09/01/2021
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