Healthcare Provider Details

I. General information

NPI: 1043127079
Provider Name (Legal Business Name): RACHEL NICOLE MASTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 N DIXIELAND RD
LITTLE FLOCK AR
72756-6817
US

IV. Provider business mailing address

3415 N DIXIELAND RD
LITTLE FLOCK AR
72756-6817
US

V. Phone/Fax

Practice location:
  • Phone: 479-346-5459
  • Fax: 479-346-5954
Mailing address:
  • Phone: 479-346-5459
  • Fax: 479-346-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA5160
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: