Healthcare Provider Details

I. General information

NPI: 1427973767
Provider Name (Legal Business Name): KAIZZ J. V. VASQUEZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ALDERSGATE RD
LITTLE ROCK AR
72205-6613
US

IV. Provider business mailing address

1601 ALDERSGATE RD
LITTLE ROCK AR
72205-6613
US

V. Phone/Fax

Practice location:
  • Phone: 501-687-0851
  • Fax: 501-687-0853
Mailing address:
  • Phone: 501-687-0851
  • Fax: 501-687-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5933
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: