Provider Demographics
NPI:1639136807
Name:THERATEAM REHAB SERVICES
Entity Type:Organization
Organization Name:THERATEAM REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH LANGUAGE PATHOLOGI
Authorized Official - Prefix:MRS
Authorized Official - First Name:REEDA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSE, CCC-SLP
Authorized Official - Phone:501-868-4760
Mailing Address - Street 1:20900 ROLAND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9685
Mailing Address - Country:US
Mailing Address - Phone:501-868-4760
Mailing Address - Fax:501-868-6498
Practice Address - Street 1:20900 ROLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9685
Practice Address - Country:US
Practice Address - Phone:501-868-4760
Practice Address - Fax:501-868-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #1076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148906742Medicaid
AR5F297OtherBCBS GROUP PROVIDER #