Provider Demographics
NPI:1295773919
Name:STAMP, BETH (PT, DPT, PCS)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:STAMP
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CHIMNEY ROCK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5846
Mailing Address - Country:US
Mailing Address - Phone:501-912-6403
Mailing Address - Fax:501-843-2270
Practice Address - Street 1:1500 WILSON LOOP
Practice Address - Street 2:
Practice Address - City:WARD
Practice Address - State:AR
Practice Address - Zip Code:72176-8656
Practice Address - Country:US
Practice Address - Phone:501-941-5630
Practice Address - Fax:501-843-2270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT10562251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120359721Medicaid
AR5S950OtherBLUE CROSS BLUE SHEILD