Healthcare Provider Details

I. General information

NPI: 1316589997
Provider Name (Legal Business Name): RYLEE COUNCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 S GRANDVIEW DR
DE WITT AR
72042-3449
US

IV. Provider business mailing address

200 W BROADWAY ST
WEST MEMPHIS AR
72301-3904
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-4651
  • Fax:
Mailing address:
  • Phone: 870-394-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4495
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR4147
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: