1659700490 NPI number — ASHLEY J PERKINS

Table of content: (NPI 1659700490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659700490 NPI number — ASHLEY J PERKINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHLEY J PERKINS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTEGRITY HEALTH CENTER PHYSICAL THERAPY DIVISION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659700490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
775 E PARKVIEW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLIVAR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65613-1367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-704-4072
Provider Business Mailing Address Fax Number:
870-743-9881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 E CRANDALL AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72601-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-704-4072
Provider Business Practice Location Address Fax Number:
870-743-9881
Provider Enumeration Date:
11/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
870-704-4072

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT3602 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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