Provider Demographics
NPI:1689622912
Name:KO, STEVEN C (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:KO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 SE 22ND ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4310
Mailing Address - Country:US
Mailing Address - Phone:479-273-9933
Mailing Address - Fax:479-273-9935
Practice Address - Street 1:203 SE 22ND ST
Practice Address - Street 2:SUITE 9
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4310
Practice Address - Country:US
Practice Address - Phone:479-273-9933
Practice Address - Fax:479-273-9935
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164492742Medicaid
AR2082512000OtherQUALCHOICE
712695OtherACN GROUP
ARPT2772OtherARK STATE BOARD OF PT
AR5Y077OtherBLUE CROSS BLUE SHIELD
712695OtherACN GROUP