Provider Demographics
NPI:1639140973
Name:JOSEPH, STEPHEN (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:JOSEPH
Suffix:
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 1:3900 N PARKVIEW DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6398
Mailing Address - Country:US
Mailing Address - Phone:479-527-9966
Mailing Address - Fax:479-527-9677
Practice Address - Street 1:4706 S THOMPSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-2548
Practice Address - Country:US
Practice Address - Phone:479-202-0441
Practice Address - Fax:479-202-0441
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59106OtherBCBS PROVIDER #