Provider Demographics
NPI:1497077648
Name:PHYSICAL THERAPY INSTITUTE
Entity Type:Organization
Organization Name:PHYSICAL THERAPY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LAGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, FAAOMPT
Authorized Official - Phone:501-804-3558
Mailing Address - Street 1:PO BOX 241574
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0011
Mailing Address - Country:US
Mailing Address - Phone:501-804-3558
Mailing Address - Fax:501-251-1165
Practice Address - Street 1:1909 HINSON LOOP RD STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3903
Practice Address - Country:US
Practice Address - Phone:501-301-4530
Practice Address - Fax:501-251-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy