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General NPI Number Information
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NPI Number | 1720057748
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Entity Type | Individual
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Provider Name | KATHRYN LOUISE SPROUSE PT
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3215N NORTHILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-463-1115
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Fax | 479-463-5118
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Provider Business Mailing Address
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Address Line | 3611 W WEIR RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5906
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Country | US
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Telephone | 479-443-3564
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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 | PT296
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License Number State | AR
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