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NPI Code Detail

MEDICARE: RONNIE LEE EAST P.T.A.

MEDICARE: RONNIE LEE EAST P.T.A.
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
1225200000XPhysical Therapy AssistantPTA 2104AR

General Provider Information

NPI Number : 1700923612
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONNIE LEE EAST P.T.A.
Provider Business Mailing Address
First Line : 1321 PARK ST
Second Line :
City : NASHVILLE
State : AR
Zip : 71852-3624
Country : US
Telephone Number : 870-918-4909
Fax Number :
Provider Business Practice Location Address
First Line : 22 SOUTHPARK SHOPPING CTR
Second Line :
City : NASHVILLE
State : AR
Zip : 71852-3307
Country : US
Telephone Number : 870-845-5600
Fax Number : 870-845-5605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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Directions to “ RONNIE LEE EAST P.T.A.” Practice Location

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