Provider Demographics
NPI:1790576502
Name:TORRE-FROST, SIDDHARTHA FRANCIS
Entity type:Individual
Prefix:
First Name:SIDDHARTHA
Middle Name:FRANCIS
Last Name:TORRE-FROST
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 1:2693 N VALENCIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3363
Mailing Address - Country:US
Mailing Address - Phone:845-853-3735
Mailing Address - Fax:
Practice Address - Street 1:2502 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3170
Practice Address - Country:US
Practice Address - Phone:479-636-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1617463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist