Individual
KELSIE WIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2474 E JOYCE BLVD, STE 2, FAYETTEVILLE, AR 72703-4519
(479) 521-8326
(479) 521-5439
Mailing address
2474 E JOYCE BLVD, STE 2, FAYETTEVILLE, AR 72703-4519
(479) 521-8326
(479) 521-5439
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4030
AR
Other
Enumeration date
08/12/2015
Last updated
08/12/2015
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