Provider Demographics
NPI:1265532543
Name:SPA CITY THERAPY INC
Entity type:Organization
Organization Name:SPA CITY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOWERBUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:501-525-2273
Mailing Address - Street 1:1635 HIGDON FERRY RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6913
Mailing Address - Country:US
Mailing Address - Phone:501-525-2273
Mailing Address - Fax:501-525-1773
Practice Address - Street 1:1635 HIGDON FERRY RD
Practice Address - Street 2:SUITE G
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-525-2273
Practice Address - Fax:501-525-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1620261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148913742Medicaid
AR5C629OtherBLUE CROSS BLUE SHIELD
AR5C629OtherBLUE CROSS BLUE SHIELD