Provider Demographics
NPI:1821751595
Name:FELTS, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FELTS
Suffix:
Gender:F
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:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1168
Mailing Address - Country:US
Mailing Address - Phone:501-328-5878
Mailing Address - Fax:501-336-0119
Practice Address - Street 1:1065 CLAYTON ST STE 9
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4335
Practice Address - Country:US
Practice Address - Phone:501-328-5878
Practice Address - Fax:501-336-0119
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist