Provider Demographics
NPI:1871694471
Name:COTHERN, DANIEL CHRISTOPHER (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHRISTOPHER
Last Name:COTHERN
Suffix:
Gender:M
Credentials: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 13525
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-0525
Mailing Address - Country:US
Mailing Address - Phone:866-251-1227
Mailing Address - Fax:866-251-1267
Practice Address - Street 1:1998 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5077
Practice Address - Country:US
Practice Address - Phone:866-251-1227
Practice Address - Fax:866-251-1267
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2286261QP2000X
ARPT 2286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163436721Medicaid