Healthcare Provider Details

I. General information

NPI: 1366537771
Provider Name (Legal Business Name): CHRISTOPHER BRIAN DENHAM RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FT. ROOTS DR. BLDG 170, RM GN102 ROUTING: 116/NLR
NORTH LITTLE ROCK AR
72114
US

IV. Provider business mailing address

9432 W. LAKE CIR
SHERWOOD AR
72120
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3026
  • Fax:
Mailing address:
  • Phone: 501-833-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: