Provider Demographics
NPI:1245293950
Name:SOUTHEAST ARKANSAS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:SOUTHEAST ARKANSAS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORNBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-541-0003
Mailing Address - Street 1:2801 S OLIVE ST
Mailing Address - Street 2:SUITE 9D
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5439
Mailing Address - Country:US
Mailing Address - Phone:870-541-0003
Mailing Address - Fax:870-541-0008
Practice Address - Street 1:2801 S OLIVE ST
Practice Address - Street 2:SUITE 9D
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5439
Practice Address - Country:US
Practice Address - Phone:870-541-0003
Practice Address - Fax:870-541-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7099039OtherAETNA
AR5C236OtherHEALTH ADVANTAGE
ARCB6528OtherMEDICARE RAILROAD
AR147503400OtherDEPT OF LABOR
AR6420055OtherUNITED HEALTHCARE
AR135098742Medicaid
AR5C236OtherBLUE CROSS BLUE SHIELD
AR135098742Medicaid
AR7099039OtherAETNA