Healthcare Provider Details

I. General information

NPI: 1710100730
Provider Name (Legal Business Name): JOANNE A GOLUCH P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W MAPLE AVE
SPRINGDALE AR
72764-5333
US

IV. Provider business mailing address

266 COUNTY ROAD 3027
EUREKA SPRINGS AR
72632-9721
US

V. Phone/Fax

Practice location:
  • Phone: 479-253-1815
  • Fax:
Mailing address:
  • Phone: 479-253-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT2620
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: