Healthcare Provider Details

I. General information

NPI: 1164645370
Provider Name (Legal Business Name): CHRISTY A WOJTKOWSKI RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N DETROIT ST
DANVILLE AR
72833
US

IV. Provider business mailing address

2314 W 7TH ST
RUSSELLVILLE AR
72801-5507
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-6326
  • Fax: 479-495-3336
Mailing address:
  • Phone: 479-495-6326
  • Fax: 479-495-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1613
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: