Provider Demographics
NPI:1043349236
Name:WORTHAM, RICHARD BRETT (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BRETT
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 EASTBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9375
Mailing Address - Country:US
Mailing Address - Phone:870-561-3747
Mailing Address - Fax:870-561-3748
Practice Address - Street 1:600 WEST HWY 18
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-561-3747
Practice Address - Fax:870-561-3747
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist