Provider Demographics
NPI:1437278264
Name:PREWETT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PREWETT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PREWETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-664-6630
Mailing Address - Street 1:32 REYNARD ESTATES DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210
Mailing Address - Country:US
Mailing Address - Phone:501-664-6630
Mailing Address - Fax:501-664-6630
Practice Address - Street 1:32 REYNARD ESTATES DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210
Practice Address - Country:US
Practice Address - Phone:501-664-6630
Practice Address - Fax:501-664-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-09-07
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C580Medicare ID - Type Unspecified