Healthcare Provider Details

I. General information

NPI: 1932396009
Provider Name (Legal Business Name): JENNIFER BERNADEAN MASSEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GRASSE ST.
CALICO ROCK AR
72519
US

IV. Provider business mailing address

103 GRASSE ST.
CALICO ROCK AR
72519
US

V. Phone/Fax

Practice location:
  • Phone: 870-297-3726
  • Fax: 870-297-4161
Mailing address:
  • Phone: 870-297-3726
  • Fax: 870-297-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2127
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: