Healthcare Provider Details

I. General information

NPI: 1235538281
Provider Name (Legal Business Name): MEREDITH OLIVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

IV. Provider business mailing address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-3600
  • Fax: 501-227-4021
Mailing address:
  • Phone: 501-227-3600
  • Fax: 501-227-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3882
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: