Healthcare Provider Details

I. General information

NPI: 1740263987
Provider Name (Legal Business Name): LOUELA SEBAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE 7
HARRISON AR
72601-2914
US

IV. Provider business mailing address

PO BOX 841
HARRISON AR
72602-0841
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-5573
  • Fax: 870-743-5974
Mailing address:
  • Phone: 870-743-5573
  • Fax: 870-743-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1576
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: