Healthcare Provider Details

I. General information

NPI: 1528547098
Provider Name (Legal Business Name): CHANCE A WALLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BALCOM LN
TRUMANN AR
72472-9502
US

IV. Provider business mailing address

4305 E BEKAH DR UNIT 5
JONESBORO AR
72404-7958
US

V. Phone/Fax

Practice location:
  • Phone: 870-418-1000
  • Fax:
Mailing address:
  • Phone: 870-283-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5896
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: