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General NPI Number Information
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NPI Number | 1821915844
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Entity Type | Individual
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Provider Name | SHELLEY DAWN COURDIN PTA
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Gender | Female
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 2793 E MILLENNIUM DR STE 2
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6522
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Country | US
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Telephone | 479-521-2232
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Fax | 479-521-0513
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Provider Business Mailing Address
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Address Line | 1350 S GUTENSOHN RD STE 10
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City | SPRINGDALE
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State | AR
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Zip | 72762-5210
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Country | US
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Telephone | 479-751-7122
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Fax | 479-751-7292
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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 | PTA1554
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License Number State | AR
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