Healthcare Provider Details

I. General information

NPI: 1750581286
Provider Name (Legal Business Name): BETH HUTCHISON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 I-630
LITTLE ROCK AR
72205-7202
US

IV. Provider business mailing address

12521 MEMORY LN
ALEXANDER AR
72002-8825
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2686
  • Fax:
Mailing address:
  • Phone: 501-316-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberAR2012
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: