Healthcare Provider Details

I. General information

NPI: 1164657185
Provider Name (Legal Business Name): DAVID LEIGH KOTY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 HIGHWAY 31 N
BEEBE AR
72012-9787
US

IV. Provider business mailing address

1647 HIGHWAY 31 N
BEEBE AR
72012-9787
US

V. Phone/Fax

Practice location:
  • Phone: 501-207-3378
  • Fax:
Mailing address:
  • Phone: 501-207-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1762
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: