Provider Demographics
NPI:1356646632
Name:INDUSTRIAL AND SPORTS REHAB LLC
Entity Type:Organization
Organization Name:INDUSTRIAL AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEJERANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-704-9800
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0861
Mailing Address - Country:US
Mailing Address - Phone:870-704-9800
Mailing Address - Fax:
Practice Address - Street 1:212 S LINCOLN ST
Practice Address - Street 2:STE D
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9782
Practice Address - Country:US
Practice Address - Phone:870-704-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty