Provider Demographics
NPI:1356654362
Name:LIBBEY MEMORIAL PHYSICAL MEDICINE CENTER, INC.
Entity Type:Organization
Organization Name:LIBBEY MEMORIAL PHYSICAL MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-620-9812
Mailing Address - Street 1:389 LAKE HAMILTON DR
Mailing Address - Street 2:A7
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6899
Mailing Address - Country:US
Mailing Address - Phone:501-620-9812
Mailing Address - Fax:501-545-4891
Practice Address - Street 1:389 LAKE HAMILTON DR
Practice Address - Street 2:A7
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6899
Practice Address - Country:US
Practice Address - Phone:501-620-9812
Practice Address - Fax:501-545-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty