Provider Demographics
NPI:1578257333
Name:WONDERWORX PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:WONDERWORX PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-428-1918
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72157-0133
Mailing Address - Country:US
Mailing Address - Phone:501-208-1401
Mailing Address - Fax:
Practice Address - Street 1:504 S CRAWFORD ST # A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4006
Practice Address - Country:US
Practice Address - Phone:479-345-8650
Practice Address - Fax:479-345-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty