Provider Demographics
NPI:1568583755
Name:CHAFFIN, SAMUEL COLE (MSPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:COLE
Last Name:CHAFFIN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S OLIVE ST
Mailing Address - Street 2:SUITE 9D
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5433
Mailing Address - Country:US
Mailing Address - Phone:870-541-0003
Mailing Address - Fax:870-541-0008
Practice Address - Street 1:2801 S OLIVE ST
Practice Address - Street 2:SUITE 9D
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5433
Practice Address - Country:US
Practice Address - Phone:870-541-0003
Practice Address - Fax:870-541-0008
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130070721Medicaid
AR5T405OtherBLUE CROSS BLUE SHIELD