Provider Demographics
NPI:1336477603
Name:OZARK AGILITY PROFESSIONALS LLC
Entity Type:Organization
Organization Name:OZARK AGILITY PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBAG-STOCKSTILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-577-7388
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0841
Mailing Address - Country:US
Mailing Address - Phone:870-577-7388
Mailing Address - Fax:870-743-5974
Practice Address - Street 1:816 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2915
Practice Address - Country:US
Practice Address - Phone:870-577-7388
Practice Address - Fax:870-743-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty