Healthcare Provider Details

I. General information

NPI: 1558489468
Provider Name (Legal Business Name): AMANDA SUE PIPPINGER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STILLWATER DR
JONESBORO AR
72404-9119
US

IV. Provider business mailing address

1900 STILLWATER DR
JONESBORO AR
72404-9119
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-3600
  • Fax: 870-932-3611
Mailing address:
  • Phone: 870-932-3600
  • Fax: 870-932-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2059
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2532
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: