Healthcare Provider Details

I. General information

NPI: 1942936588
Provider Name (Legal Business Name): PAUL KUIPERS DPT, CLT-LANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 BURGESS LN
GREENBRIER AR
72058-9641
US

IV. Provider business mailing address

58 BURGESS LN
GREENBRIER AR
72058-9641
US

V. Phone/Fax

Practice location:
  • Phone: 501-402-0787
  • Fax:
Mailing address:
  • Phone: 501-402-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3398
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: