Provider Demographics
NPI:1558860999
Name:MILLAR, BENYAHMIN (PTA)
Entity Type:Individual
Prefix:
First Name:BENYAHMIN
Middle Name:
Last Name:MILLAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 AIRPORT RD STE E
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-9266
Mailing Address - Country:US
Mailing Address - Phone:479-667-3710
Mailing Address - Fax:479-667-3712
Practice Address - Street 1:257 AIRPORT RD STE E
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-9266
Practice Address - Country:US
Practice Address - Phone:479-667-3710
Practice Address - Fax:479-667-3712
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4286225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant