Individual
SARA J WHITLOCK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2703 W MAIN ST, RUSSELLVILLE, AR 72801-2456
(479) 890-5494
(479) 968-0069
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-4273
(479) 968-1363
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
PT745
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S636
BCBS
AR
Enumeration date
06/15/2006
Last updated
07/08/2007
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