Provider Demographics
NPI:1376551325
Name:ESB REHAB SERVICES INC.
Entity Type:Organization
Organization Name:ESB REHAB SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICSON
Authorized Official - Middle Name:SARIEGO
Authorized Official - Last Name:BACSA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-933-2055
Mailing Address - Street 1:2701 S CARAWAY RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7304
Mailing Address - Country:US
Mailing Address - Phone:870-933-2055
Mailing Address - Fax:870-910-0245
Practice Address - Street 1:2701 S CARAWAY RD
Practice Address - Street 2:SUITE B2
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7304
Practice Address - Country:US
Practice Address - Phone:870-933-2055
Practice Address - Fax:870-910-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C641OtherBC/BS