Provider Demographics
NPI:1548068885
Name:HEAVNER, ANITA KAY (PT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:KAY
Last Name:HEAVNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:134 HILLVIEW DRIVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAIRFIELD BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72088
Mailing Address - Country:US
Mailing Address - Phone:501-884-6884
Mailing Address - Fax:501-884-6886
Practice Address - Street 1:134 HILLVIEW DR.
Practice Address - Street 2:SUITE 6
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-7203
Practice Address - Country:US
Practice Address - Phone:501-884-6884
Practice Address - Fax:501-884-6886
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist