Provider Demographics
NPI:1861676058
Name:TRILOGY THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:TRILOGY THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-860-3500
Mailing Address - Street 1:PO BOX 24915
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-4915
Mailing Address - Country:US
Mailing Address - Phone:501-221-3908
Mailing Address - Fax:800-661-8025
Practice Address - Street 1:10121 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 7
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5549
Practice Address - Country:US
Practice Address - Phone:501-221-3908
Practice Address - Fax:800-661-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR046598Medicare Oscar/Certification