Healthcare Provider Details

I. General information

NPI: 1497346647
Provider Name (Legal Business Name): GARRETT STEADHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 GOLF LINKS ROAD
HOT SPRINGS AR
71901
US

IV. Provider business mailing address

114 STARLITE BAY STREET
HOT SPRINGS AR
71913
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-7149
  • Fax:
Mailing address:
  • Phone: 501-318-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4524
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: