Healthcare Provider Details

I. General information

NPI: 1548627326
Provider Name (Legal Business Name): REBEKAH FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N RODNEY PARHAM RD SUITE 102
LITTLE ROCK AR
72212-2461
US

IV. Provider business mailing address

4200 N RODNEY PARHAM RD SUITE 102
LITTLE ROCK AR
72212-2461
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-0336
  • Fax: 501-661-0412
Mailing address:
  • Phone: 501-661-0336
  • Fax: 501-661-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4048
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: