Individual
TRISTAN NATHANIEL TIARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
306 E 11TH ST, RUSSELLVILLE, AR 72801-6156
(479) 967-1178
Mailing address
1580 EDGESTONE CIR, CONWAY, AR 72034-8717
(479) 619-5514
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3288
AR
Other
Enumeration date
09/10/2010
Last updated
09/10/2010
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