Provider Demographics
NPI:1477802247
Name:RISIUS, DAVID SCOTT (MS PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:RISIUS
Suffix:
Gender:M
Credentials:MS PT
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Mailing Address - Street 1:PO BOX 13525
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-0525
Mailing Address - Country:US
Mailing Address - Phone:866-251-1227
Mailing Address - Fax:866-251-1267
Practice Address - Street 1:1401 LABELLE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2315
Practice Address - Country:US
Practice Address - Phone:866-251-1227
Practice Address - Fax:501-251-1267
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2022-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARPT 1774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist