Provider Demographics
NPI:1972863637
Name:LONG, NANCY LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNN
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 SOUTHSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ODEN
Mailing Address - State:AR
Mailing Address - Zip Code:71961-8094
Mailing Address - Country:US
Mailing Address - Phone:501-701-6343
Mailing Address - Fax:
Practice Address - Street 1:105 RESERVE ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4195
Practice Address - Country:US
Practice Address - Phone:501-701-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist