Provider Demographics
NPI:1417455239
Name:HEDLEY, ARIANNE (PTA)
Entity type:Individual
Prefix:
First Name:ARIANNE
Middle Name:
Last Name:HEDLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UNIVERSAL CITY PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91608-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3719 88TH ST NE STE A
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7228
Practice Address - Country:US
Practice Address - Phone:360-659-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2024-08-23
Deactivation Date:2024-08-16
Deactivation Code:
Reactivation Date:2024-08-22
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WAP161553745225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician