Basic Information
| Provider Information | |||||||||
| NPI: | 1538112974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAUTHEN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 11230 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729171230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797097000 | ||||||||
| FaxNumber: | 4797097051 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 W. E. KNIGHT DRIVE | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797097000 | ||||||||
| FaxNumber: | 4797097051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2676 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5X485 | 01 | AR | AR BC/BS | OTHER |