Provider Demographics
NPI:1275200768
Name:CURTIS, WHITLEY A (PTA)
Entity Type:Individual
Prefix:
First Name:WHITLEY
Middle Name:A
Last Name:CURTIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 OAK GROVE CIR APT 5
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2413
Mailing Address - Country:US
Mailing Address - Phone:870-316-7239
Mailing Address - Fax:
Practice Address - Street 1:2800 S 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7030
Practice Address - Country:US
Practice Address - Phone:501-286-6075
Practice Address - Fax:501-286-6175
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4556225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant