Healthcare Provider Details

I. General information

NPI: 1679530455
Provider Name (Legal Business Name): HOLLY DENISE CALAWAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/30/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 MAIN ST
BRYANT AR
72022-9188
US

IV. Provider business mailing address

3231 MAIN ST
BRYANT AR
72022-9188
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberAR2682
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2682
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: