Provider Demographics
NPI:1457318081
Name:FELLERS, DENNIS JOHN (RPT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JOHN
Last Name:FELLERS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 RICE ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4388
Mailing Address - Country:US
Mailing Address - Phone:870-423-6789
Mailing Address - Fax:870-423-6385
Practice Address - Street 1:210 RICE ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4388
Practice Address - Country:US
Practice Address - Phone:870-423-6789
Practice Address - Fax:870-423-6385
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 626225100000X
MOR0802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR01947Medicare UPIN