Provider Demographics
NPI:1346877214
Name:ARKANSAS PELVIC HEALTH PLLC
Entity Type:Organization
Organization Name:ARKANSAS PELVIC HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:615-955-0225
Mailing Address - Street 1:10825 KANIS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3872
Mailing Address - Country:US
Mailing Address - Phone:501-420-3884
Mailing Address - Fax:
Practice Address - Street 1:10825 KANIS RD STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3872
Practice Address - Country:US
Practice Address - Phone:501-420-3884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1710396403OtherBCBS