Healthcare Provider Details

I. General information

NPI: 1407402969
Provider Name (Legal Business Name): STEFFEN LUCAS O'BRIEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5532 JFK BLVD
NORTH LITTLE ROCK AR
72116-6708
US

IV. Provider business mailing address

5532 JFK BLVD
NORTH LITTLE ROCK AR
72116-6708
US

V. Phone/Fax

Practice location:
  • Phone: 501-588-3211
  • Fax:
Mailing address:
  • Phone: 501-588-3211
  • Fax: 805-788-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT302326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: