Provider Demographics
NPI:1942266440
Name:PRIMARILY PEDIATRICS, INC
Entity Type:Organization
Organization Name:PRIMARILY PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:DJUANA
Authorized Official - Middle Name:FRESNEDA
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:501-354-1133
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-0322
Mailing Address - Country:US
Mailing Address - Phone:501-354-1133
Mailing Address - Fax:501-354-1133
Practice Address - Street 1:4912 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:AR
Practice Address - Zip Code:72157-9669
Practice Address - Country:US
Practice Address - Phone:501-354-1133
Practice Address - Fax:501-354-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty