Healthcare Provider Details

I. General information

NPI: 1528316510
Provider Name (Legal Business Name): SHEILA FEFERBAUM-JONES LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W POPLAR ST
ROGERS AR
72756-4242
US

IV. Provider business mailing address

820 MICHAEL ST
CENTERTON AR
72719-8996
US

V. Phone/Fax

Practice location:
  • Phone: 479-631-7678
  • Fax: 479-631-8886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2669
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: