Active NPI
Samantha Henderson
- Physical Therapy Assistant
- De Queen, AR
National Provider Identifier
1306536164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA4811
- Practice address
- 300 W Collin Raye Dr SPC 106
De Queen, AR 71832-2007 - Phone
- (870) 584-1085
- Fax
- (870) 584-1095
- NPI assigned
- May 15, 2023
- Last updated
- May 15, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA4811 | AR | Primary |
Addresses
Primary practice location
300 W Collin Raye Dr SPC 106
De Queen, AR 71832-2007
Mailing address
300 W Collin Raye Dr SPC 106
De Queen, AR 71832-2007
Phone (870) 584-1085
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA4811 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1306536164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W COLLIN RAYE DR SPC 106",
"city": "DE QUEEN",
"state": "AR",
"postal_code": "718322007",
"telephone_number": "870-584-1085",
"fax_number": "870-584-1095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W COLLIN RAYE DR SPC 106",
"city": "DE QUEEN",
"state": "AR",
"postal_code": "718322007",
"telephone_number": "870-584-1085",
"fax_number": "870-584-1095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-15",
"last_updated": "2023-05-15",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA4811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Queen, AR
- Healthcare Express, LLP (HealthCARE Express)
- Healthcare Express, LLP (Healthcare Express)
- Healthy Connections Inc
- Healthy Connections Inc
- Hearing Aid Innovations Ar, LLC (Padgett Hearing Aid Center)
- Kimberly Henritze, COTA
- Jaymee Hess, PTA
- Dena Kaye Hibbs, APRN
- Kylie Anne Higgins
- Carolin Tapia Hockersmith, APRN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.