Provider Demographics
NPI:1821233438
Name:NWA ORTHOSPINE REHAB SERVICES INC
Entity Type:Organization
Organization Name:NWA ORTHOSPINE REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBAG-STOCKSTILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-444-6768
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0841
Mailing Address - Country:US
Mailing Address - Phone:479-444-6768
Mailing Address - Fax:
Practice Address - Street 1:2783 N SHILOH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6983
Practice Address - Country:US
Practice Address - Phone:479-444-6768
Practice Address - Fax:479-444-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty