Provider Demographics
NPI:1467136820
Name:OUACHITA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:OUACHITA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:501-359-3802
Mailing Address - Street 1:321 SECTION LINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6483
Mailing Address - Country:US
Mailing Address - Phone:501-359-3802
Mailing Address - Fax:501-359-3803
Practice Address - Street 1:321 SECTION LINE RD STE E
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6483
Practice Address - Country:US
Practice Address - Phone:501-701-0410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty