Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT1104 | AR |
N | 2251H1200X | Hand | PT1104 | AR |
NPI | 1285790592 |
---|---|
Provider Name | Mr. Richard Douglas Dekok |
First Address | Jonesboro, AR 72404-8702 |
Second Address | Jonesboro, AR 72401-6621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |