Healthcare Provider Details

I. General information

NPI: 1164264339
Provider Name (Legal Business Name): COLBIE DANIELLE FELTY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLBIE DANIELLE MCPHERSON PTA

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 RECTOR RD
PARAGOULD AR
72450-2004
US

IV. Provider business mailing address

1910 RECTOR RD
PARAGOULD AR
72450-2004
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-3600
  • Fax:
Mailing address:
  • Phone: 870-932-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5114
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: