Healthcare Provider Details

I. General information

NPI: 1063880292
Provider Name (Legal Business Name): LANCE PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 W MARKHAM ST
LITTLE ROCK AR
72205-2123
US

IV. Provider business mailing address

PO BOX 30022
LITTLE ROCK AR
72260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 501-737-4320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 3982
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2401018
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: