1609290097 NPI number — PHYSICAL THERAPY WORKS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609290097 NPI number — PHYSICAL THERAPY WORKS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY WORKS, INC.
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:
Provider Other Organization Name Type Code:
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:
1609290097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 HIGHWAY 62 412
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72542-9497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-856-9675
Provider Business Mailing Address Fax Number:
870-856-9679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 HIGHWAY 62 412
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72542-9497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-856-9675
Provider Business Practice Location Address Fax Number:
870-856-9679
Provider Enumeration Date:
02/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TERRY
Authorized Official First Name:
STEPHENIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
870-856-9675

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2125 , 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)

  • Identifier: 134409721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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