Healthcare Provider Details

I. General information

NPI: 1093626491
Provider Name (Legal Business Name): MADISON FLEMING PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S PARK AVE
STUTTGART AR
72160-6346
US

IV. Provider business mailing address

5702 HIGHWAY 1 W
DUMAS AR
71639-8029
US

V. Phone/Fax

Practice location:
  • Phone: 870-940-0052
  • Fax:
Mailing address:
  • Phone: 870-940-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: