Provider Demographics
NPI:1720316235
Name:SPORTS PLUS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SPORTS PLUS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PREWETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-996-2525
Mailing Address - Street 1:250 OLD HACKETT ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936
Mailing Address - Country:US
Mailing Address - Phone:479-996-2525
Mailing Address - Fax:479-996-2526
Practice Address - Street 1:250 OLD HACKETT ROAD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936
Practice Address - Country:US
Practice Address - Phone:479-996-2525
Practice Address - Fax:479-996-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty