Provider Demographics
NPI:1881081081
Name:RECTOR, MALINDA ANN (ATC)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:ANN
Last Name:RECTOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 MEADOWSWEET DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-8875
Mailing Address - Country:US
Mailing Address - Phone:479-841-5107
Mailing Address - Fax:
Practice Address - Street 1:11105 MEADOWSWEET DR
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-8875
Practice Address - Country:US
Practice Address - Phone:479-841-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer