Provider Demographics
NPI:1417424524
Name:WINGFIELD PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:WINGFIELD PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:WINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-344-1642
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0309
Mailing Address - Country:US
Mailing Address - Phone:870-344-1642
Mailing Address - Fax:833-234-2006
Practice Address - Street 1:1626 S MADISON ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3003
Practice Address - Country:US
Practice Address - Phone:870-344-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy