Healthcare Provider Details

I. General information

NPI: 1851725204
Provider Name (Legal Business Name): SARA MARIE JOHNSGARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 10/28/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S FULTON ST
CLARKSVILLE AR
72830-3612
US

IV. Provider business mailing address

108 LED LN
DOVER AR
72837-8229
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-4060
  • Fax:
Mailing address:
  • Phone: 479-747-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2726
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: