Provider Demographics
NPI:1922469246
Name:BRANCH THERAPY, PLLC
Entity Type:Organization
Organization Name:BRANCH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER-INCORPORATOR/ CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-255-6609
Mailing Address - Street 1:1202 NE MCCLAIN RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3875
Mailing Address - Country:US
Mailing Address - Phone:616-255-6609
Mailing Address - Fax:
Practice Address - Street 1:1202 NE MCCLAIN RD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3875
Practice Address - Country:US
Practice Address - Phone:616-255-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#4018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty