Provider Demographics
NPI:1558324939
Name:DEWITT, TERRY LEN (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEN
Last Name:DEWITT
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 OUACHITA ST.
Mailing Address - Street 2:JONES SCIENCE CENTER, ROOM 426
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71998-3700
Mailing Address - Country:US
Mailing Address - Phone:870-245-5264
Mailing Address - Fax:870-245-5241
Practice Address - Street 1:410 OUACHITA ST.
Practice Address - Street 2:JONES SCIENCE CENTER, ROOM 426
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71998-3700
Practice Address - Country:US
Practice Address - Phone:870-245-5264
Practice Address - Fax:870-245-5241
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT1242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer