Provider Demographics
NPI:1700843612
Name:OZARK PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:OZARK PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:870-423-6789
Mailing Address - Street 1:210 RICE ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4388
Mailing Address - Country:US
Mailing Address - Phone:870-423-6789
Mailing Address - Fax:870-423-6385
Practice Address - Street 1:210 RICE ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4388
Practice Address - Country:US
Practice Address - Phone:870-423-6789
Practice Address - Fax:870-423-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56141OtherBCBS PROVIDER NO.
AR56141OtherBCBS PROVIDER NO.
AR046584Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.