Healthcare Provider Details

I. General information

NPI: 1124955588
Provider Name (Legal Business Name): MITZILA LIZBETH JONES MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HALSTED CIR STE 5
ROGERS AR
72756-3150
US

IV. Provider business mailing address

1 HALSTED CIR STE 5
ROGERS AR
72756-3150
US

V. Phone/Fax

Practice location:
  • Phone: 479-396-7760
  • Fax:
Mailing address:
  • Phone: 479-396-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9210
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: