Provider Demographics
NPI:1437294766
Name:PENDERGRASS THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PENDERGRASS THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-857-0049
Mailing Address - Street 1:1700 W MAIN ST
Mailing Address - Street 2:P.O. BOX 511
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-1903
Mailing Address - Country:US
Mailing Address - Phone:870-857-0049
Mailing Address - Fax:870-857-3027
Practice Address - Street 1:1700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-1903
Practice Address - Country:US
Practice Address - Phone:870-857-0049
Practice Address - Fax:870-857-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135320742Medicaid
AR135320742Medicaid
AR135320742Medicaid