Provider Demographics
NPI:1073632576
Name:PHYSICAL THERAPY SERVICES OF CLEBURNE COUNTY, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF CLEBURNE COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-362-2525
Mailing Address - Street 1:408 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3017
Mailing Address - Country:US
Mailing Address - Phone:501-362-2525
Mailing Address - Fax:501-362-2751
Practice Address - Street 1:408 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3017
Practice Address - Country:US
Practice Address - Phone:501-362-2525
Practice Address - Fax:501-362-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR404261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56302Medicare ID - Type Unspecified