Provider Demographics
NPI:1760090849
Name:PASCHALL, ROGER ALAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ALAN
Last Name:PASCHALL
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 1:12904 HIGHWAY 5 LOT 26
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7703
Mailing Address - Country:US
Mailing Address - Phone:501-259-1632
Mailing Address - Fax:
Practice Address - Street 1:6124 NORTHMOOR DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2504
Practice Address - Country:US
Practice Address - Phone:501-765-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1805225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty