Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT 1615 | AR |
NPI | 1003856725 |
---|---|
Provider Name | Mrs. Heidi Marie Epperson |
First Address | Rogers, AR 72758-3936 |
Second Address | Bentonville, AR 72712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 13/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126411721 | (05) | AR |
5U213 | BLUE CROSS (01) | AR |