Provider Demographics
NPI:1598963555
Name:PHILPOT, LANA KAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:KAY
Last Name:PHILPOT
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 1:157 POLK 652
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-8214
Mailing Address - Country:US
Mailing Address - Phone:479-394-2783
Mailing Address - Fax:479-394-7667
Practice Address - Street 1:400 CRESTWOOD CIR STE G
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5512
Practice Address - Country:US
Practice Address - Phone:479-394-7979
Practice Address - Fax:479-394-7667
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2064225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant