Healthcare Provider Details

I. General information

NPI: 1396555942
Provider Name (Legal Business Name): RHONDA CLEAVENGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 W VILLAGE PKWY STE 6
ROGERS AR
72758-8137
US

IV. Provider business mailing address

1401 FLORENTINE RD
CENTERTON AR
72719-6030
US

V. Phone/Fax

Practice location:
  • Phone: 479-936-2978
  • Fax:
Mailing address:
  • Phone: 479-586-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1256
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: