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NPI Code Detail

MEDICARE: MR. SOHN MCLEAN PTA

MEDICARE: MR. SOHN MCLEAN PTA
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 AssistantPTA1299AR

General Provider Information

NPI Number : 1831464502
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SOHN MCLEAN PTA
Provider Business Mailing Address
First Line : 3410 JACK CULLEN DR
Second Line :
City : TEXARKANA
State : AR
Zip : 71854-2548
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 826 NORTH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-4522
Country : US
Telephone Number : 870-533-4444
Fax Number : 870-533-8841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2012
Last Update Date : 03/14/2012

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