Provider Demographics
NPI:1164859286
Name:OLDHAM, VALARIE RANAE (DPT)
Entity type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:RANAE
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:VALARIE
Other - Middle Name:RANAE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:827 E MAIN
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315
Mailing Address - Country:US
Mailing Address - Phone:870-763-8155
Mailing Address - Fax:870-838-1589
Practice Address - Street 1:827 E MAIN
Practice Address - Street 2:SUITE B
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315
Practice Address - Country:US
Practice Address - Phone:870-763-8155
Practice Address - Fax:870-838-1589
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist