Healthcare Provider Details

I. General information

NPI: 1235050329
Provider Name (Legal Business Name): BROOKLYN MARIE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 ELLSWORTH RD
FORT SMITH AR
72903-3224
US

IV. Provider business mailing address

208 MARSHALL AVE
MANSFIELD AR
72944-2603
US

V. Phone/Fax

Practice location:
  • Phone: 479-322-0546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5113
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: