Provider Demographics
NPI:1841507043
Name:NOLEN, JEFFREY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:NOLEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 KAVANAUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3231 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9188
Practice Address - Country:US
Practice Address - Phone:501-847-0500
Practice Address - Fax:501-847-0508
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist