Healthcare Provider Details

I. General information

NPI: 1043790793
Provider Name (Legal Business Name): MURPHY DIANNE PERKINS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 T P WHITE DR
JACKSONVILLE AR
72076-2514
US

IV. Provider business mailing address

2701 T P WHITE DR
JACKSONVILLE AR
72076-2514
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax: 501-241-0125
Mailing address:
  • Phone: 501-241-0410
  • Fax: 501-241-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4511
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: