Jacob Buchanan
Individual provider Active NPI Physical Therapy Assistant · Marion, AR
NPI 1164037941 · NPPES record last updated Sep 9, 2020
Key facts
- NPI
- 1164037941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 4516 (AR)
- Practice address
- 924 State Highway 77
Marion, AR 72364-9004 - Phone
- (601) 650-6286
- NPI assigned
- Sep 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4516 | AR | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 4516 | AR | Yes |
Addresses
Primary practice location
924 State Highway 77
Marion, AR 72364-9004
Mailing address
832 Bayou Vista Dr
Marion, AR 72364-5006
Phone (601) 650-6286
Other providers in Marion, AR
- Jessica Brown
- Marriott Brown
- Nicole Brown
- Sikamgila Wyki Brown
- Teresa Brown
- Blayne Bullard
- Nan Bullard
- Shonna Danielle Burnett
- Johnny Hilton Burns Sr.
- John Michael Burrows
All providers in Marion, AR · Physical Therapy Assistant in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.