Provider Demographics
NPI:1851097174
Name:DANIELS, CONCIETTA (PT, DPT, LSVT)
Entity Type:Individual
Prefix:DR
First Name:CONCIETTA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PT, DPT, LSVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 SALEM RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4855
Mailing Address - Country:US
Mailing Address - Phone:501-932-0055
Mailing Address - Fax:
Practice Address - Street 1:318 STROZIER LN
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2323
Practice Address - Country:US
Practice Address - Phone:479-452-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist