Provider Demographics
NPI:1275628950
Name:WORKPLACE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WORKPLACE PHYSICAL THERAPY
Other - Org Name:DELTA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:501-833-2675
Mailing Address - Street 1:PO BOX 6253
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72124-6253
Mailing Address - Country:US
Mailing Address - Phone:501-833-2675
Mailing Address - Fax:501-833-0325
Practice Address - Street 1:825 TRAMMEL RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2155
Practice Address - Country:US
Practice Address - Phone:501-833-2675
Practice Address - Fax:501-833-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154767742Medicaid
AR142776721Medicaid
AR5W286Medicare ID - Type UnspecifiedINDIVIDUAL PROV. #
AR142776721Medicaid