Healthcare Provider Details

I. General information

NPI: 1740118421
Provider Name (Legal Business Name): MIRANDA CHAMBERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13133 HIGHWAY 107
SHERWOOD AR
72120-2404
US

IV. Provider business mailing address

4801 FAIRWAY AVE
NORTH LITTLE ROCK AR
72116-8009
US

V. Phone/Fax

Practice location:
  • Phone: 501-392-6590
  • Fax: 501-392-6538
Mailing address:
  • Phone: 501-758-1300
  • Fax: 501-758-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4956
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: