Healthcare Provider Details

I. General information

NPI: 1659110161
Provider Name (Legal Business Name): MARY HEATHER THOMPSON RRT, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

IV. Provider business mailing address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-4301
  • Fax:
Mailing address:
  • Phone: 479-443-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License NumberRCP-3124
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: