Individual
SANDRA RAYBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17706 I-30, STE. 3, BENTON, AR 72019-2907
(501) 315-4414
(501) 315-0075
Mailing address
17706 I-30, STE. 3, BENTON, AR 72019-2907
(501) 315-4414
(501) 315-0075
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT770
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116192721
—
AR
01
—
56237
BLUE CROSS BLUE SHIELD
AR
Enumeration date
05/21/2007
Last updated
01/16/2013
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