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NPI Code Detail

MEDICARE: ALYSSA RACHEL DIMITROV DPT

MEDICARE: ALYSSA RACHEL DIMITROV DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4330AR

General Provider Information

NPI Number : 1083131064
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA RACHEL DIMITROV DPT
Provider Business Mailing Address
First Line : 2668 E CITIZENS DR STE 5
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4796
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2668 E CITIZENS DR STE 5
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4796
Country : US
Telephone Number : 479-442-7473
Fax Number : 479-239-5444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2017
Last Update Date : 07/07/2025

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Directions to “ ALYSSA RACHEL DIMITROV DPT” Practice Location

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