Provider Demographics
NPI:1669807228
Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity type:Organization
Organization Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/MANAGER OUTPATIENT THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ORELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-686-6102
Mailing Address - Street 1:629 JACK STEPHENS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5525
Mailing Address - Country:US
Mailing Address - Phone:501-526-5770
Mailing Address - Fax:501-526-5775
Practice Address - Street 1:629 JACK STEPHENS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5525
Practice Address - Country:US
Practice Address - Phone:501-526-5770
Practice Address - Fax:501-526-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 1810261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy