Healthcare Provider Details

I. General information

NPI: 1316042906
Provider Name (Legal Business Name): PAMELA P. WREN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MUSEUM RD STE 104
CONWAY AR
72032-4761
US

IV. Provider business mailing address

1500 MUSEUM RD STE 104
CONWAY AR
72032-4761
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3804
  • Fax: 501-329-0718
Mailing address:
  • Phone: 501-329-3804
  • Fax: 501-329-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number247
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: