MEDICARE: WILLADEAN CLAUDETTE CLOWE RPT

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	PT1829	AR

General Provider Information

NPI Number	:	1942267687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLADEAN CLAUDETTE CLOWE RPT

Provider Business Mailing Address
First Line	:	6000 MEADOW BROOK DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-9115
Country	:	US
Telephone Number	:	479-782-1900
Fax Number	:	479-782-0787

Provider Business Practice Location Address
First Line	:	6000 MEADOW BROOK DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-9115
Country	:	US
Telephone Number	:	479-782-1900
Fax Number	:	479-782-0787

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	01/11/2021

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