Provider Demographics
NPI:1437696440
Name:BENTONVILLE PHYSICAL THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:BENTONVILLE PHYSICAL THERAPY SPECIALISTS
Other - Org Name:THAT'S THE KNOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROBERTOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:479-268-6040
Mailing Address - Street 1:907 SE VILLAGE LOOP STE 5
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-2229
Mailing Address - Country:US
Mailing Address - Phone:479-268-6040
Mailing Address - Fax:479-431-5098
Practice Address - Street 1:907 SE VILLAGE LOOP STE 5
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-2229
Practice Address - Country:US
Practice Address - Phone:479-268-6040
Practice Address - Fax:479-431-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 42402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty