Provider Demographics
NPI:1952678179
Name:STOREY, VIRGINIA L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:L
Last Name:STOREY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 LA ROUGE CT
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-3940
Mailing Address - Country:US
Mailing Address - Phone:479-640-2472
Mailing Address - Fax:
Practice Address - Street 1:801 LA ROUGE CT
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-3940
Practice Address - Country:US
Practice Address - Phone:479-640-2472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2560225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant