Provider Demographics
NPI:1245609551
Name:GRAGSTON, BOBBY (DPT)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:GRAGSTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 BILL FOSTER MEMORIAL HIGHWAY WEST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-941-3320
Mailing Address - Fax:501-224-5460
Practice Address - Street 1:10014 NORTH RODNEY PARHAM
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227
Practice Address - Country:US
Practice Address - Phone:501-224-5454
Practice Address - Fax:501-224-5460
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT4051OtherPT LICENSE