Individual
MARY RUTH PERSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1601 ALDERSGATE RD, LITTLE ROCK, AR 72205-6613
(501) 687-0851
(501) 687-0853
Mailing address
1601 ALDERSGATE ROAD, LITTLE ROCK, AR 72205
(501) 687-0851
(501) 687-0853
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3179
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179776721
—
AR
01
—
5V266
BLUE CROSS BLUE SHIELD
AR
01
—
P00848712
RAILROAD MEDICARE
—
Enumeration date
09/14/2009
Last updated
12/16/2015
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