Provider Demographics
NPI:1801872304
Name:ARKANSAS CENTER FOR PHYSICAL MEDICINE & REHABILITATION
Entity type:Organization
Organization Name:ARKANSAS CENTER FOR PHYSICAL MEDICINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDLYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FRENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-374-1153
Mailing Address - Street 1:636 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5526
Mailing Address - Country:US
Mailing Address - Phone:501-374-1153
Mailing Address - Fax:501-374-6213
Practice Address - Street 1:636 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5526
Practice Address - Country:US
Practice Address - Phone:501-374-1153
Practice Address - Fax:501-374-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR992111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR350052757OtherRAILROAD MEDICARE
AR59014OtherDR. BENNETT PIN
AR1619281185OtherNPI-DR MORSE
AR1093083271OtherDR. SETH WILSON NPI
AR15723OtherLICENSE-DR. DAVID MORSE
AR15924OtherDR. SETH WILSON LICENSE
AR1801872304OtherGROUP NPI
AR57869OtherMEDICARE GROUP PIN
AR5AN27OtherDR. SETH WILSON UPIN
ART20518OtherDR. BENNETT UPIN