Healthcare Provider Details

I. General information

NPI: 1841507043
Provider Name (Legal Business Name): JEFFREY NOLEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 MAIN ST SUITE 3
BRYANT AR
72022-9188
US

IV. Provider business mailing address

6304 KAVANAUGH BLVD
LITTLE ROCK AR
72207-4255
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-0500
  • Fax: 501-847-0508
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3279
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: