Healthcare Provider Details

I. General information

NPI: 1538385190
Provider Name (Legal Business Name): WENDY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 HIGHWAY 365 STE 365
MAYFLOWER AR
72106-9524
US

IV. Provider business mailing address

582 HIGHWAY 365 STE 365
MAYFLOWER AR
72106-9524
US

V. Phone/Fax

Practice location:
  • Phone: 501-470-3500
  • Fax: 501-470-3502
Mailing address:
  • Phone: 501-470-3500
  • Fax: 501-470-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1656
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: