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General NPI Number Information
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NPI Number | 1376429159
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Entity Type | Individual
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Provider Name | ELYSIAN LAUREN REEDER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 221 N EAST ST
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City | BENTON
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State | AR
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Zip | 72015-3867
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Country | US
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Telephone | 501-301-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 11420 BASS PRO PKWY STE 2316
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City | LITTLE ROCK
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State | AR
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Zip | 72210-3094
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Country | US
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Telephone | 501-520-1763
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5738
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License Number State | AR
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