Provider Demographics
NPI:1407166325
Name:MORRIS, DEVON (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 RICE CIR
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-3342
Mailing Address - Country:US
Mailing Address - Phone:501-676-1684
Mailing Address - Fax:
Practice Address - Street 1:102 RICE CIR
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3342
Practice Address - Country:US
Practice Address - Phone:501-676-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183419721Medicaid