Individual
BARRON TRACY SOUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, PT
Contact information
Practice address
505 E DOUBLE EAGLE PL, FAYETTEVILLE, AR 72701-7143
(479) 856-6571
(479) 856-6571
Mailing address
505 E DOUBLE EAGLE PL, FAYETTEVILLE, AR 72701-7143
(479) 856-6571
(479) 856-6571
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
C22172
AR
225100000X
Physical Therapist
Primary
PT 1781
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129332721
—
AR
Enumeration date
01/27/2006
Last updated
09/14/2009
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