Healthcare Provider Details

I. General information

NPI: 1710608872
Provider Name (Legal Business Name): ARASH CIRRUS HOJATIZADEH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 N MARKET AVE STE 4
FAYETTEVILLE AR
72703-3561
US

IV. Provider business mailing address

PO BOX 871
TONTITOWN AR
72770-0871
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-6277
  • Fax: 479-444-6278
Mailing address:
  • Phone: 479-444-6277
  • Fax: 479-444-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5152
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: