Healthcare Provider Details

I. General information

NPI: 1982052106
Provider Name (Legal Business Name): MR. TALON DUANE SCHOLZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 FIREHOUSE RD
HENSLEY AR
72065-8038
US

IV. Provider business mailing address

708 FIREHOUSE RD
HENSLEY AR
72065-8038
US

V. Phone/Fax

Practice location:
  • Phone: 501-200-2763
  • Fax:
Mailing address:
  • Phone: 501-200-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4090
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: