Healthcare Provider Details

I. General information

NPI: 1316631872
Provider Name (Legal Business Name): ALISON LYNN SPAGNOLO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON LYNN NOGA DPT

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N PARKVIEW DR
FAYETTEVILLE AR
72703-6398
US

IV. Provider business mailing address

3900 N PARKVIEW DR
FAYETTEVILLE AR
72703-6398
US

V. Phone/Fax

Practice location:
  • Phone: 479-966-4187
  • Fax: 579-966-4197
Mailing address:
  • Phone: 479-966-4187
  • Fax: 479-966-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11897
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: