Provider Demographics
NPI:1114067485
Name:KEARNEY, LIZA GARCIA (RPT)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:GARCIA
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 CLUB HOUSE PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8703
Mailing Address - Country:US
Mailing Address - Phone:479-267-0443
Mailing Address - Fax:
Practice Address - Street 1:11503 CLUB HOUSE PKWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8703
Practice Address - Country:US
Practice Address - Phone:479-267-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist