=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255645685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY DWAYNE PYLE CRT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2010
-----------------------------------------------------
Last Update Date | 07/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 CALELLA RD
-----------------------------------------------------
City | HOT SPRINGS VILLAGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71909-3174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-984-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 ASPE LN
-----------------------------------------------------
City | HOT SPRINGS VILLAGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71909-3339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-520-1455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 2265
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------