Provider Demographics
NPI:1780083428
Name:ADVANCED PHYSICAL THERAPY - CABOT LLC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY - CABOT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-5454
Mailing Address - Street 1:10014 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227
Mailing Address - Country:US
Mailing Address - Phone:501-224-5454
Mailing Address - Fax:501-224-5460
Practice Address - Street 1:2251 BILL FOSTER MEMORIAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7200
Practice Address - Country:US
Practice Address - Phone:501-941-3320
Practice Address - Fax:501-941-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1755261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5D458OtherBLUE CROSS BLUE SHIELD
AR5T563Medicare UPIN
ARNPI 1144265190OtherINDIVIDUAL NPI
AR143565721Medicaid
ARP00412703OtherRAILROAD MEDICARE
AR5T563F776OtherMEDICARE GROUP ID