Provider Demographics
NPI:1528016102
Name:STINNETT & SCARBROUGH P.A,
Entity Type:Organization
Organization Name:STINNETT & SCARBROUGH P.A,
Other - Org Name:HOLLY STREET PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-524-8028
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1379
Mailing Address - Country:US
Mailing Address - Phone:479-524-8028
Mailing Address - Fax:479-524-6151
Practice Address - Street 1:1675 W. JEFFERSON
Practice Address - Street 2:SUITE A
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-1379
Practice Address - Country:US
Practice Address - Phone:479-524-8028
Practice Address - Fax:479-524-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C517Medicare ID - Type UnspecifiedGROUP CLINIC NUMBER