Provider Demographics
NPI:1912101908
Name:LICHTI, CARRIE JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JEAN
Last Name:LICHTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:JEAN
Other - Last Name:FORDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8326
Mailing Address - Country:US
Mailing Address - Phone:501-760-7440
Mailing Address - Fax:501-760-7442
Practice Address - Street 1:1510 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6652
Practice Address - Country:US
Practice Address - Phone:501-760-7440
Practice Address - Fax:501-760-7442
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist