Individual
DOUGLAS LOGAN DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
100 CALELLA RD STE 100, HOT SPRINGS VILLAGE, AR 71909-3174
(501) 984-2453
(501) 525-1773
Mailing address
400 BAYSHORE DR APT B, HOT SPRINGS, AR 71901-9630
(318) 792-7987
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1300819
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1300819
TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
TX
Enumeration date
02/02/2018
Last updated
03/17/2018
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