Provider Demographics
NPI:1063909885
Name:DAILEY, KATIE M (PT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11900 KANIS RD STE D4
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3769
Mailing Address - Country:US
Mailing Address - Phone:501-221-1600
Mailing Address - Fax:501-801-1065
Practice Address - Street 1:11900 KANIS RD STE D4
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3769
Practice Address - Country:US
Practice Address - Phone:501-221-1600
Practice Address - Fax:501-801-1065
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR2397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2397OtherPHYSICAL THERAPY