=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598619611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER STRIDE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 449 N GOOSE XING
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72730-6020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-651-8541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 N GOOSE XING
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72730-6020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-651-8541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PHYSICAL THERAPY
-----------------------------------------------------
Name | DR. CONCIETTA WATTS
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 479-651-8541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251G0304X
-----------------------------------------------------
Taxonomy Name | Geriatric Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------