Healthcare Provider Details

I. General information

NPI: 1982960019
Provider Name (Legal Business Name): PATRICE MICHELLE LLOYD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ELDRIDGE RD SUITE 1
FORREST CITY AR
72335-9516
US

IV. Provider business mailing address

211 W WOOD AVE
PALESTINE AR
72372-9161
US

V. Phone/Fax

Practice location:
  • Phone: 870-633-3278
  • Fax: 870-633-3285
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2579
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: