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Individual

LAUREN PRUITT FORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
1200 N JAMES ST STE A, JACKSONVILLE, AR 72076-3167
(501) 241-0410
Mailing address
1200 N JAMES ST STE A, JACKSONVILLE, AR 72076-3167
(501) 241-0410

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 2046
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
157635721
AR
Enumeration date
04/26/2006
Last updated
08/14/2009
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