Provider Demographics
NPI:1477854859
Name:CALDWELL, ANNELLE RAE (PTA)
Entity Type:Individual
Prefix:
First Name:ANNELLE
Middle Name:RAE
Last Name:CALDWELL
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 1:3400 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9523
Mailing Address - Country:US
Mailing Address - Phone:479-461-2320
Mailing Address - Fax:
Practice Address - Street 1:3400 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-9523
Practice Address - Country:US
Practice Address - Phone:479-648-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 960225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant