Healthcare Provider Details

I. General information

NPI: 1346207123
Provider Name (Legal Business Name): BARBARA LYNNE KETCHUM MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 KANIS RD
LITTLE ROCK AR
72205-6205
US

IV. Provider business mailing address

PO BOX 55270
LITTLE ROCK AR
72215-5270
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-4170
  • Fax: 501-604-3223
Mailing address:
  • Phone: 501-604-4170
  • Fax: 501-604-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberAR1888
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: