Individual
WANDA ADMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
4801 FAIRWAY AVE, NORTH LITTLE ROCK, AR 72116-8009
(501) 758-1300
(501) 758-1316
Mailing address
4801 FAIRWAY AVE, NORTH LITTLE ROCK, AR 72116-8009
(501) 758-1300
(501) 758-1300
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT514
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184103721
—
AR
01
—
5V214
BCBS
—
Enumeration date
04/19/2007
Last updated
09/12/2011
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