Provider Demographics
NPI:1467482265
Name:CENTRAL ARKANSAS SPORTS MEDICINE
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENHSAW
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, ATC
Authorized Official - Phone:501-758-1300
Mailing Address - Street 1:2400 CRESTWOOD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7665
Mailing Address - Country:US
Mailing Address - Phone:501-758-1300
Mailing Address - Fax:501-758-1316
Practice Address - Street 1:2400 CRESTWOOD
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7665
Practice Address - Country:US
Practice Address - Phone:501-758-1300
Practice Address - Fax:501-758-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C856OtherBLUE CROSS/ BLUE SHIELD
AR5734850001Medicare NSC
AR5C856Medicare ID - Type Unspecified