Provider Demographics
NPI:1275514838
Name:GLENWOOD PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:GLENWOOD PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:870-356-6044
Mailing Address - Street 1:253 HIGHWAY 70 E
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-8801
Mailing Address - Country:US
Mailing Address - Phone:870-356-6044
Mailing Address - Fax:870-356-6045
Practice Address - Street 1:253 HIGHWAY 70 E
Practice Address - Street 2:SUITE D
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-8801
Practice Address - Country:US
Practice Address - Phone:870-356-6044
Practice Address - Fax:870-356-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C799OtherARKANSAS BCBS
AR5C799OtherARKANSAS BCBS