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NPI Code Detail

MEDICARE: TERRY WOMBLE PT

MEDICARE:   TERRY  WOMBLE  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
1225100000XPhysical TherapistPT2719AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT2719OTHERARAR STATE BOARD PT LICENSE

General Provider Information

NPI Number : 1710086244
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY WOMBLE PT
Provider Business Mailing Address
First Line : 1007 WINDOVER RD STE A
Second Line :
City : JONESBORO
State : AR
Zip : 72401-6009
Country : US
Telephone Number : 870-934-5725
Fax Number :
Provider Business Practice Location Address
First Line : 1007 WINDOVER RD STE A
Second Line :
City : JONESBORO
State : AR
Zip : 72401-6009
Country : US
Telephone Number : 870-934-5725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 08/28/2007

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Directions to “ TERRY WOMBLE PT” Practice Location

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