Provider Demographics
NPI:1457415861
Name:DENTON, SAMUEL B (PT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:B
Last Name:DENTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10
Mailing Address - Street 2:COUNTY ROAD 364
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416
Mailing Address - Country:US
Mailing Address - Phone:870-931-4668
Mailing Address - Fax:
Practice Address - Street 1:505 E MATTHEWS AVE
Practice Address - Street 2:STE. 205
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3144
Practice Address - Country:US
Practice Address - Phone:870-932-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist