Provider Demographics
NPI:1053199505
Name:FUTRELL, WINSTON TYLER (DPT)
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:TYLER
Last Name:FUTRELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 N CORAL CANYON LOOP APT 105
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6284
Mailing Address - Country:US
Mailing Address - Phone:870-208-5950
Mailing Address - Fax:
Practice Address - Street 1:2668 E CITIZENS DR STE 5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4796
Practice Address - Country:US
Practice Address - Phone:479-595-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist