Individual
LANCE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
347 HIGHWAY 62 E, MOUNTAIN HOME, AR 72653-3655
(870) 701-5089
(870) 277-0896
Mailing address
PO BOX 2398, MOUNTAIN HOME, AR 72654-2398
(870) 404-5299
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1939
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131825721
—
AR
Enumeration date
03/22/2007
Last updated
01/09/2020
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