Individual
TOM G BAXLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3071 W 28TH AVE, PINE BLUFF, AR 71603-4802
(870) 534-4414
Mailing address
30 CONCORD DR, WHITE HALL, AR 71602-2834
(870) 267-1426
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134
LICENSE #
AR
Enumeration date
08/14/2006
Last updated
07/08/2007
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