Healthcare Provider Details

I. General information

NPI: 1104731892
Provider Name (Legal Business Name): RICHARD FELICITAS JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RJ FELICITAS PT

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

11340 SOUTHRIDGE DR
LITTLE ROCK AR
72212-1832
US

V. Phone/Fax

Practice location:
  • Phone: 501-441-3453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5188
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: