Provider Demographics
NPI:1437218658
Name:NORTHEAST ARKANSAS ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-268-1400
Mailing Address - Street 1:2919 E MATTHEWS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4499
Mailing Address - Country:US
Mailing Address - Phone:870-268-1400
Mailing Address - Fax:870-268-1405
Practice Address - Street 1:2919 E MATTHEWS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4499
Practice Address - Country:US
Practice Address - Phone:870-268-1400
Practice Address - Fax:870-268-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C671OtherBCBS PROVIDER NUMBER