Healthcare Provider Details

I. General information

NPI: 1124944798
Provider Name (Legal Business Name): LEAH DIANNE DAVENPORT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S GUTENSOHN RD STE 10
SPRINGDALE AR
72762-5210
US

IV. Provider business mailing address

1350 S GUTENSOHN RD STE 10
SPRINGDALE AR
72762-5210
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-7122
  • Fax: 479-751-7292
Mailing address:
  • Phone: 479-751-7122
  • Fax: 479-751-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1302
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: