Provider Demographics
NPI:1356404446
Name:TUMLISON, NATHAN C (PT,MS,OCS,CERT MDT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:C
Last Name:TUMLISON
Suffix:
Gender:M
Credentials:PT,MS,OCS,CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6613
Mailing Address - Country:US
Mailing Address - Phone:501-687-0851
Mailing Address - Fax:501-687-0853
Practice Address - Street 1:1601 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-687-0851
Practice Address - Fax:501-687-0853
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150763742Medicaid
AR150758721Medicaid
AR5X452OtherBLUE CROSS
ARP00094056Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AR150758721Medicaid