Healthcare Provider Details

I. General information

NPI: 1104522069
Provider Name (Legal Business Name): TIFFANY WESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 HWY 5 NORTH SUITE 300
BRYANT AR
72022
US

IV. Provider business mailing address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204-1720
US

V. Phone/Fax

Practice location:
  • Phone: 501-500-3500
  • Fax: 501-904-3620
Mailing address:
  • Phone: 501-404-8007
  • Fax: 501-904-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5259
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: