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General NPI Number Information
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NPI Number | 1417424524
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Entity Type | Organization
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Legal Business Name | WINGFIELD PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 1626 S MADISON ST
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City | DE WITT
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State | AR
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Zip | 72042-3003
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Country | US
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Telephone | 870-344-1642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | DE WITT
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State | AR
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Zip | 72042-0309
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Country | US
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Telephone | 870-344-1642
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Fax | 833-234-2006
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Authorized Official
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Title or Position | PHYSICAL THERAPY
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Name | MRS. JENNIFER KATE WINGFIELD
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Credential | PT
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Telephone | 870-344-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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