Provider Demographics
NPI:1598858375
Name:CONWAY PHYSICAL THERAPY CLINIC, PA
Entity Type:Organization
Organization Name:CONWAY PHYSICAL THERAPY CLINIC, PA
Other - Org Name:CONWAY THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-329-3804
Mailing Address - Street 1:1500 MUSEUM RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4710
Mailing Address - Country:US
Mailing Address - Phone:501-329-3804
Mailing Address - Fax:501-329-0718
Practice Address - Street 1:1500 MUSEUM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4710
Practice Address - Country:US
Practice Address - Phone:501-329-3804
Practice Address - Fax:501-329-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57038OtherARBCBS