Healthcare Provider Details

I. General information

NPI: 1821152257
Provider Name (Legal Business Name): LISSA L GILL PRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HIGHWAY 25B SUITE A1
HEBER SPRINGS AR
72543-6417
US

IV. Provider business mailing address

2000 HIGHWAY 25B NORTH SUITE A1
HEBER SPRINGS AR
72543-6417
US

V. Phone/Fax

Practice location:
  • Phone: 501-362-7195
  • Fax: 501-362-7855
Mailing address:
  • Phone: 501-362-7195
  • Fax: 501-362-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT720
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: