Healthcare Provider Details

I. General information

NPI: 1407166325
Provider Name (Legal Business Name): DEVON MORRIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEVON CLARK

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RICE CIR
LONOKE AR
72086-3342
US

IV. Provider business mailing address

102 RICE CIR
LONOKE AR
72086-3342
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-1684
  • Fax:
Mailing address:
  • Phone: 501-676-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3173
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: