Provider Demographics
NPI:1265311450
Name:PUMCHAMNONG, PAT (DPT)
Entity type:Individual
Prefix:
First Name:PAT
Middle Name:
Last Name:PUMCHAMNONG
Suffix:
Gender:X
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27017 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72940-9406
Mailing Address - Country:US
Mailing Address - Phone:479-312-2343
Mailing Address - Fax:
Practice Address - Street 1:27017 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:AR
Practice Address - Zip Code:72940-9406
Practice Address - Country:US
Practice Address - Phone:479-312-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist