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General NPI Number Information
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NPI Number | 1972367829
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Entity Type | Individual
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Provider Name | JONATHAN PUTNAM
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 4847 KAYLEE AVE STE B
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City | SPRINGDALE
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State | AR
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Zip | 72762-0872
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Country | US
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Telephone | 479-756-5002
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 W CLEARWOOD DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6127
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Country | US
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Telephone | 479-200-0309
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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 | 4386
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License Number State | AR
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