Healthcare Provider Details

I. General information

NPI: 1811891518
Provider Name (Legal Business Name): JON CHRISTOPHER RACIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WATER AVE
ELM SPRINGS AR
72762-7091
US

IV. Provider business mailing address

1000 SWN DR STE 101
CONWAY AR
72032-2558
US

V. Phone/Fax

Practice location:
  • Phone: 479-480-8509
  • Fax:
Mailing address:
  • Phone: 501-328-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA5149
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: