Healthcare Provider Details

I. General information

NPI: 1831464502
Provider Name (Legal Business Name): SOHN MCLEAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 NORTH ST
STAMPS AR
71860-4522
US

IV. Provider business mailing address

3410 JACK CULLEN DR
TEXARKANA AR
71854-2548
US

V. Phone/Fax

Practice location:
  • Phone: 870-533-4444
  • Fax: 870-533-8841
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1299
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: