Healthcare Provider Details

I. General information

NPI: 1457275679
Provider Name (Legal Business Name): PEYTON DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FORT ST
BARLING AR
72923-2153
US

IV. Provider business mailing address

207 AMHERST CIR
FORT SMITH AR
72908-8230
US

V. Phone/Fax

Practice location:
  • Phone: 479-739-6511
  • Fax:
Mailing address:
  • Phone: 479-431-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1617647
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: