Provider Demographics
NPI:1942192786
Name:YOUNG, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:BLACK ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72415-9030
Mailing Address - Country:US
Mailing Address - Phone:870-759-0227
Mailing Address - Fax:
Practice Address - Street 1:75 HIGHWAY 62 412 STE L
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9629
Practice Address - Country:US
Practice Address - Phone:870-243-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5052225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant