Provider Demographics
NPI:1235202060
Name:WITHERSPOON, CHAMBLEE BENTLEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHAMBLEE
Middle Name:BENTLEY
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 LAYMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9143
Mailing Address - Country:US
Mailing Address - Phone:870-636-7571
Mailing Address - Fax:870-934-1270
Practice Address - Street 1:1217 LAYMAN DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9143
Practice Address - Country:US
Practice Address - Phone:870-636-7571
Practice Address - Fax:870-934-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154576721Medicaid