Individual
SIERRA DOMERESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1915 W MAIN ST, RUSSELLVILLE, AR 72801-2725
(479) 968-1198
Mailing address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-1198
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
09/08/2021
Last updated
09/08/2021
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