Basic Information
| Provider Information | |||||||||
| NPI: | 1497346647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEADHAM | ||||||||
| FirstName: | GARRETT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 STARLITE BAY STREET | ||||||||
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| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013183468 | ||||||||
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| Practice Location | |||||||||
| Address1: | 552 GOLF LINKS ROAD | ||||||||
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| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016247149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2021 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA4524 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.