Provider Demographics
NPI:1962617092
Name:RICHEY, CHRISTY (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:RICHEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3442 HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:AR
Mailing Address - Zip Code:72458-9007
Mailing Address - Country:US
Mailing Address - Phone:870-878-1123
Mailing Address - Fax:
Practice Address - Street 1:3442 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:AR
Practice Address - Zip Code:72458-9007
Practice Address - Country:US
Practice Address - Phone:870-878-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2113225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant