Healthcare Provider Details

I. General information

NPI: 1154519684
Provider Name (Legal Business Name): DONALD EUGENE LITCHFORD LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 N PLAINVIEW AVE
FAYETTEVILLE AR
72703-4065
US

IV. Provider business mailing address

PO BOX 8475
FAYETTEVILLE AR
72703-0008
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-4001
  • Fax: 479-521-1621
Mailing address:
  • Phone: 479-252-0084
  • Fax: 479-521-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2219
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: