Provider Demographics
NPI:1750762308
Name:BEYOND BOUNDARIES THERAPY SERVICES, P.A.
Entity type:Organization
Organization Name:BEYOND BOUNDARIES THERAPY SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SPEARS
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:870-565-8677
Mailing Address - Street 1:5975 GREENE 707 ROAD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-565-8677
Mailing Address - Fax:
Practice Address - Street 1:5975 GREENE 707 RD.
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-565-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
ARSP#1381235Z00000X
ARPT2195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty