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General NPI Number Information
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NPI Number | 1336331701
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Entity Type | Individual
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Provider Name | NANCY DENISE DRACE PTA
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Gender | Female
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 661 HIGHWAY 64B
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City | WYNNE
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State | AR
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Zip | 72396-8506
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Country | US
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Telephone | 870-208-9572
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CYPRESS CRK
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City | MARION
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State | AR
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Zip | 72364-9747
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Country | US
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Telephone | 901-496-3189
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1806
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License Number State | AR
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