Healthcare Provider Details

I. General information

NPI: 1619976420
Provider Name (Legal Business Name): JENNIFER DIANE USREY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 HIGHWAY 62 65 N STE A
HARRISON AR
72601-1959
US

IV. Provider business mailing address

253 COUNTY ROAD 998
ALPENA AR
72611-9003
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-4438
  • Fax: 870-741-0736
Mailing address:
  • Phone: 870-743-4438
  • Fax: 870-741-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1784
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: