Provider Demographics
NPI:1063463081
Name:FLOYD, WAYMON (PT)
Entity Type:Individual
Prefix:
First Name:WAYMON
Middle Name:
Last Name:FLOYD
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 1:350 E MILLSAP RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4098
Mailing Address - Country:US
Mailing Address - Phone:479-442-4495
Mailing Address - Fax:479-442-8178
Practice Address - Street 1:350 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4098
Practice Address - Country:US
Practice Address - Phone:479-442-4495
Practice Address - Fax:479-442-8178
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA002OtherTRICARE
AR5X487OtherBCBS
AR5X487OtherBCBS