Healthcare Provider Details

I. General information

NPI: 1407250236
Provider Name (Legal Business Name): WILL MAASS MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HENDERSON ST
ARKADELPHIA AR
71999-0001
US

IV. Provider business mailing address

389 LAKE HAMILTON DR APT F17
HOT SPRINGS AR
71913-6875
US

V. Phone/Fax

Practice location:
  • Phone: 870-230-5426
  • Fax:
Mailing address:
  • Phone: 563-210-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberAT 634
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: