Provider Demographics
NPI:1457526790
Name:ARKANSAS PAIN CENTER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ARKANSAS PAIN CENTER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-771-4370
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0308
Mailing Address - Country:US
Mailing Address - Phone:501-771-4370
Mailing Address - Fax:501-327-9722
Practice Address - Street 1:2504 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7607
Practice Address - Country:US
Practice Address - Phone:501-771-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS PAIN CENTER, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-28
Last Update Date:2020-03-19
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
AR157408742Medicaid