Healthcare Provider Details

I. General information

NPI: 1447316237
Provider Name (Legal Business Name): ALLAM DALATI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 34TH ST
ROGERS AR
72756
US

IV. Provider business mailing address

PO BOX 1972
ROGERS AR
72757-1972
US

V. Phone/Fax

Practice location:
  • Phone: 479-685-0941
  • Fax:
Mailing address:
  • Phone: 479-685-0941
  • Fax: 479-621-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLAM DALATI
Title or Position: OWNER
Credential: CP
Phone: 479-685-0941