Provider Demographics
NPI:1255829404
Name:PRO ACTIVE REHAB, INC
Entity Type:Organization
Organization Name:PRO ACTIVE REHAB, INC
Other - Org Name:PRO-ACTIVE PHYSICAL THERAPY BRYANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-1885
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1890
Mailing Address - Country:US
Mailing Address - Phone:501-776-1885
Mailing Address - Fax:501-776-1875
Practice Address - Street 1:5309 HIGHWAY 5 N STE 150
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9259
Practice Address - Country:US
Practice Address - Phone:501-847-3320
Practice Address - Fax:501-847-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty