Healthcare Provider Details

I. General information

NPI: 1295773919
Provider Name (Legal Business Name): BETH STAMP PT, DPT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WILSON LOOP
WARD AR
72176-8656
US

IV. Provider business mailing address

420 CHIMNEY ROCK DR
NORTH LITTLE ROCK AR
72120-5846
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-5630
  • Fax: 501-843-2270
Mailing address:
  • Phone: 501-912-6403
  • Fax: 501-843-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT1056
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: