Provider Demographics
NPI:1225670250
Name:SPECIALIZED PHYSICAL THERAPY OF NWA LLC
Entity Type:Organization
Organization Name:SPECIALIZED PHYSICAL THERAPY OF NWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-981-1406
Mailing Address - Street 1:3405 S 117TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4642
Mailing Address - Country:US
Mailing Address - Phone:402-981-1406
Mailing Address - Fax:866-304-4838
Practice Address - Street 1:5001 W PAULINE WHITAKER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7341
Practice Address - Country:US
Practice Address - Phone:479-903-3048
Practice Address - Fax:866-304-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty