Active NPI
Michelle Dawn Durham, LPTA
- Physical Therapist
- Pine Bluff, AR
National Provider Identifier
1316173735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTA 1459
- Practice address
- 6400 Trinity Dr
Pine Bluff, AR 71603-7802 - Phone
- (870) 879-0638
- NPI assigned
- Jun 1, 2009
- Last updated
- Jun 1, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTA 1459 | AR | Primary |
Addresses
Primary practice location
6400 Trinity Dr
Pine Bluff, AR 71603-7802
Mailing address
302 Barney CV
White Hall, AR 71602-3689
Phone (870) 879-0638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 1459 | AR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243814400000",
"number": "1316173735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 BARNEY CV",
"city": "WHITE HALL",
"state": "AR",
"postal_code": "716023689",
"telephone_number": "870-879-0638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6400 TRINITY DR",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716037802",
"telephone_number": "870-879-0638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURHAM",
"first_name": "MICHELLE",
"middle_name": "DAWN",
"name_prefix": "Ms.",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-01",
"last_updated": "2009-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PTA 1459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.