Provider Demographics
NPI:1487611596
Name:HANAN, ASHLEY CARLISLE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:CARLISLE
Last Name:HANAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 OBSIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3738
Mailing Address - Country:US
Mailing Address - Phone:501-833-4485
Mailing Address - Fax:
Practice Address - Street 1:148 OBSIDIAN DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3738
Practice Address - Country:US
Practice Address - Phone:501-833-4485
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U256OtherAR BLUE CROSS BLUE SHIELD