Healthcare Provider Details

I. General information

NPI: 1407937451
Provider Name (Legal Business Name): HEIDI HUDSPETH DUFFIELD MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI MARIE DUFFIELD MS PT

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W 7TH ST GRAND PRAIRIE PHYSICAL THERAPY, INC
DE WITT AR
72042-3279
US

IV. Provider business mailing address

PO BOX 288
DE WITT AR
72042-0288
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-8400
  • Fax: 870-946-8511
Mailing address:
  • Phone: 870-946-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2227
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: