Healthcare Provider Details

I. General information

NPI: 1659629228
Provider Name (Legal Business Name): CHADWICK EARL ATKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 AIRPORT RD SUITE E
OZARK AR
72949
US

IV. Provider business mailing address

257 AIRPORT RD SUITE E
OZARK AR
72949
US

V. Phone/Fax

Practice location:
  • Phone: 479-667-3710
  • Fax:
Mailing address:
  • Phone: 479-667-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2605
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: