MEDICARE: DOUGLAS ERROL FLEMING II PT

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
1	225100000X	Physical Therapist	PT2751	MS

General Provider Information

NPI Number	:	1497263271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ERROL FLEMING II PT

Provider Business Mailing Address
First Line	:	285 FISH BAYOU RD
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-6086
Country	:	US
Telephone Number	:	662-822-1358
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 FISH BAYOU RD
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-6086
Country	:	US
Telephone Number	:	662-822-1358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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