Healthcare Provider Details

I. General information

NPI: 1467666057
Provider Name (Legal Business Name): DINA WELSH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/08/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 N INVESTMENT DR STE 1
FAYETTEVILLE AR
72703-5458
US

IV. Provider business mailing address

3275 THORNBURY DR
SPRINGDALE AR
72764-1122
US

V. Phone/Fax

Practice location:
  • Phone: 479-435-9356
  • Fax: 479-332-4932
Mailing address:
  • Phone: 479-283-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1906069
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 1899
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: