Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 3257 | AR |
NPI | 1023320132 |
---|---|
Provider Name | Rachael Lee Cummins Owens |
First Address | Conway, AR 72034-8448 |
Second Address | Conway, AR 72032-4335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
183268721 | (05) | AR |
5V365 | (02) | AR |