Healthcare Provider Details

I. General information

NPI: 1053861807
Provider Name (Legal Business Name): REID PARNELL PT., DPT,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
US

IV. Provider business mailing address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
US

V. Phone/Fax

Practice location:
  • Phone: 501-503-3294
  • Fax: 888-630-8885
Mailing address:
  • Phone: 501-503-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4222
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: