Provider Demographics
NPI:1427191543
Name:PRO THERAPY
Entity Type:Organization
Organization Name:PRO THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-464-9672
Mailing Address - Street 1:1501 SE WALTON BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3734
Mailing Address - Country:US
Mailing Address - Phone:479-464-9672
Mailing Address - Fax:479-464-9675
Practice Address - Street 1:1501 SE WALTON BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3734
Practice Address - Country:US
Practice Address - Phone:479-464-9672
Practice Address - Fax:479-464-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty