Provider Demographics
NPI:1053204941
Name:DEEN, DOUGLAS (MSPT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DEEN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 GAZEBO DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8260
Mailing Address - Country:US
Mailing Address - Phone:501-472-0980
Mailing Address - Fax:
Practice Address - Street 1:10825 FINANCIAL CENTRE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3545
Practice Address - Country:US
Practice Address - Phone:501-223-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist