Provider Demographics
NPI:1063016582
Name:PRATHER, CLIFF MICHAEL
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:MICHAEL
Last Name:PRATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 RIVER ROAD DR W
Mailing Address - Street 2:
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-8418
Mailing Address - Country:US
Mailing Address - Phone:501-766-6489
Mailing Address - Fax:
Practice Address - Street 1:200 MAPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1998
Practice Address - Country:US
Practice Address - Phone:573-260-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist