Provider Demographics
NPI:1497263271
Name:FLEMING, DOUGLAS ERROL II (PT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ERROL
Last Name:FLEMING
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 FISH BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-6086
Mailing Address - Country:US
Mailing Address - Phone:662-822-1358
Mailing Address - Fax:
Practice Address - Street 1:285 FISH BAYOU RD
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-6086
Practice Address - Country:US
Practice Address - Phone:662-822-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist