Provider Demographics
NPI:1275515959
Name:GREENWOOD PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:GREENWOOD PHYSICAL THERAPY CENTER, INC.
Other - Org Name:GREENWOOD PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:479-996-5078
Mailing Address - Street 1:515 FORREST PARK WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-5955
Mailing Address - Country:US
Mailing Address - Phone:479-996-5078
Mailing Address - Fax:479-996-5079
Practice Address - Street 1:515 FORREST PARK WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-5955
Practice Address - Country:US
Practice Address - Phone:479-996-5078
Practice Address - Fax:479-996-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2692261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X522Medicare ID - Type Unspecified