Healthcare Provider Details

I. General information

NPI: 1861114662
Provider Name (Legal Business Name): WILLIAM WESTON HURST DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 BLACK FOREST DR STE 3
FAYETTEVILLE AR
72704-6541
US

IV. Provider business mailing address

3399 BLACK FOREST DR STE 3
FAYETTEVILLE AR
72704-6541
US

V. Phone/Fax

Practice location:
  • Phone: 479-435-6712
  • Fax: 844-317-0394
Mailing address:
  • Phone: 479-435-6712
  • Fax: 844-317-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5193
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: