Healthcare Provider Details

I. General information

NPI: 1467649533
Provider Name (Legal Business Name): SUSAN KAY THOMAS
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 STREET
CALICO ROCK AR
72519
US

IV. Provider business mailing address

103 GRASSE STREET
CALICO ROCK AR
72519-0438
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 Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2178
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: