Individual
RYAN DANIEL MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
75 INDUSTRIAL DRIVE, ASH FLAT, AR 72513
(501) 352-6105
Mailing address
291 EMERSON DR., VIOLET HILL, AR 72584
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4615
AR
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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