Provider Demographics
NPI:1376429159
Name:REEDER, ELYSIAN LAUREN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELYSIAN
Middle Name:LAUREN
Last Name:REEDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 BASS PRO PKWY STE 2316
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-3094
Mailing Address - Country:US
Mailing Address - Phone:501-520-1763
Mailing Address - Fax:
Practice Address - Street 1:221 N EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3867
Practice Address - Country:US
Practice Address - Phone:501-301-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist