Provider Demographics
NPI:1124579164
Name:MOUNTAINCREST REHABILITATION
Entity Type:Organization
Organization Name:MOUNTAINCREST REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-236-4987
Mailing Address - Street 1:1801 FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-3016
Mailing Address - Country:US
Mailing Address - Phone:479-855-9348
Mailing Address - Fax:479-855-9358
Practice Address - Street 1:1801 FOREST HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3016
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:479-855-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4153261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy