Provider Demographics
NPI:1154519684
Name:LITCHFORD, DONALD EUGENE (LPTA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EUGENE
Last Name:LITCHFORD
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8475
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0008
Mailing Address - Country:US
Mailing Address - Phone:479-252-0084
Mailing Address - Fax:479-521-1621
Practice Address - Street 1:3419 N PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4065
Practice Address - Country:US
Practice Address - Phone:479-521-4001
Practice Address - Fax:479-521-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2219225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant