Provider Demographics
NPI:1790493765
Name:RICE, BRADLEY DEAN
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DEAN
Last Name:RICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 AIRPORT RD STE E
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-9266
Mailing Address - Country:US
Mailing Address - Phone:479-667-3710
Mailing Address - Fax:
Practice Address - Street 1:257 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-9200
Practice Address - Country:US
Practice Address - Phone:479-667-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4798225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant