Healthcare Provider Details

I. General information

NPI: 1689126583
Provider Name (Legal Business Name): CHRISTIAN HUSKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 W MARKHAM ST
LITTLE ROCK AR
72205-3328
US

IV. Provider business mailing address

2360 ORCHID
CONWAY AR
72034-8456
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2659
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: