Provider Demographics
NPI:1417364704
Name:PHYSIQUES, INC.
Entity Type:Organization
Organization Name:PHYSIQUES, INC.
Other - Org Name:SOUTH ARKANSAS CARDIAC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSE, RN
Authorized Official - Phone:870-234-3488
Mailing Address - Street 1:1010 N DUDNEY RD STE E
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2651
Mailing Address - Country:US
Mailing Address - Phone:870-234-3488
Mailing Address - Fax:870-234-3488
Practice Address - Street 1:1010 N DUDNEY RD STE E
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2651
Practice Address - Country:US
Practice Address - Phone:870-234-3488
Practice Address - Fax:870-234-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QR0404X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C128Medicare PIN