Provider Demographics
NPI:1255649463
Name:KISER, ZACH
Entity type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:KISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S 48TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5848
Mailing Address - Country:US
Mailing Address - Phone:479-751-3900
Mailing Address - Fax:479-751-3011
Practice Address - Street 1:1112 S 48TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5848
Practice Address - Country:US
Practice Address - Phone:479-751-3900
Practice Address - Fax:479-751-3011
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2460225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant