Healthcare Provider Details

I. General information

NPI: 1679399117
Provider Name (Legal Business Name): RIZALITO GELICAME PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FOREST HILLS BLVD STE 205
BELLA VISTA AR
72715-3071
US

IV. Provider business mailing address

1801 FOREST HILLS BLVD STE 205
BELLA VISTA AR
72715-3071
US

V. Phone/Fax

Practice location:
  • Phone: 479-855-9348
  • Fax: 479-855-9358
Mailing address:
  • Phone: 479-855-9348
  • Fax: 479-855-9358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: