Provider Demographics
NPI:1902044126
Name:SOUTHERLAND, JOSEPH BRYAN (PHD, PT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRYAN
Last Name:SOUTHERLAND
Suffix:
Gender:M
Credentials:PHD, PT
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 1483
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-1483
Mailing Address - Country:US
Mailing Address - Phone:870-270-7954
Mailing Address - Fax:
Practice Address - Street 1:334 SFC 308
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7398
Practice Address - Country:US
Practice Address - Phone:870-270-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist