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General NPI Number Information
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NPI Number | 1760090849
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Entity Type | Individual
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Provider Name | ROGER ALAN PASCHALL PTA
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Gender | Male
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 6124 NORTHMOOR DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-2504
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Country | US
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Telephone | 501-765-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 12904 HIGHWAY 5 LOT 26
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City | CABOT
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State | AR
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Zip | 72023-7703
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Country | US
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Telephone | 501-259-1632
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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 | 1805
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License Number State | AR
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