Provider Demographics
NPI:1316293764
Name:VIRDEN, TEFFANY S (MMT)
Entity type:Individual
Prefix:MRS
First Name:TEFFANY
Middle Name:S
Last Name:VIRDEN
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 FOXCROFT RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2455
Mailing Address - Country:US
Mailing Address - Phone:501-663-0402
Mailing Address - Fax:
Practice Address - Street 1:2723 FOXCROFT RD
Practice Address - Street 2:SUITE 311
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2455
Practice Address - Country:US
Practice Address - Phone:501-663-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist