Healthcare Provider Details

I. General information

NPI: 1548183874
Provider Name (Legal Business Name): SHEA SANDEFUR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 W SUNSET AVE STE 168
SPRINGDALE AR
72762-4410
US

IV. Provider business mailing address

2668 E CITIZENS DR STE 5
FAYETTEVILLE AR
72703-4796
US

V. Phone/Fax

Practice location:
  • Phone: 479-364-6467
  • Fax:
Mailing address:
  • Phone: 479-595-0711
  • Fax: 479-239-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5879
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: