Provider Demographics
NPI:1053847004
Name:LAMBETH, VIRGIL R (EDD, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:R
Last Name:LAMBETH
Suffix:
Gender:M
Credentials:EDD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12281
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72149-0001
Mailing Address - Country:US
Mailing Address - Phone:501-279-4308
Mailing Address - Fax:501-279-4138
Practice Address - Street 1:915 E MARKET AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72149-0001
Practice Address - Country:US
Practice Address - Phone:501-279-4308
Practice Address - Fax:501-279-4138
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 2852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer