Individual
CLAYTON COUNTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3114 FOX RD, SUITE A, JONESBORO, AR 72404-9322
(870) 530-3693
(870) 933-9293
Mailing address
4010 BRANDYWINE DR, JONESBORO, AR 72404-0720
(870) 530-3693
(870) 933-9293
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA2505
AR
Other
Enumeration date
08/02/2011
Last updated
08/02/2011
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