Provider Demographics
NPI:1689923591
Name:TUTT, WAYNE THOMAS JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:THOMAS
Last Name:TUTT
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2391 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-7288
Mailing Address - Country:US
Mailing Address - Phone:501-762-4748
Mailing Address - Fax:
Practice Address - Street 1:620 CENTRAL AVE
Practice Address - Street 2:2A
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5300
Practice Address - Country:US
Practice Address - Phone:501-762-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist