Provider Demographics
NPI:1205163664
Name:CHARTON, MARIE (PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CHARTON
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 1:100 WALMART DR
Mailing Address - Street 2:STE 5
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4522
Mailing Address - Country:US
Mailing Address - Phone:501-477-2202
Mailing Address - Fax:501-421-0543
Practice Address - Street 1:100 WALMART DR
Practice Address - Street 2:STE 5
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4522
Practice Address - Country:US
Practice Address - Phone:501-477-2202
Practice Address - Fax:501-421-0543
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT30782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR195554721Medicaid
270636YN40Medicare PIN