Provider Demographics
NPI:1336527811
Name:STURDIVANT, DAMON (DPT)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:STURDIVANT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 19TH ST STE S
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1123
Mailing Address - Country:US
Mailing Address - Phone:479-631-3955
Mailing Address - Fax:479-631-0152
Practice Address - Street 1:201 S 19TH ST STE S
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1123
Practice Address - Country:US
Practice Address - Phone:479-631-3955
Practice Address - Fax:479-631-0152
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist