Provider Demographics
NPI:1801877659
Name:ARKADELPHIA PHYSICAL THERAPY CENTER, INC.
Entity type:Organization
Organization Name:ARKADELPHIA PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:870-246-8623
Mailing Address - Street 1:3030 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5325
Mailing Address - Country:US
Mailing Address - Phone:870-246-8623
Mailing Address - Fax:870-246-8694
Practice Address - Street 1:3030 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5325
Practice Address - Country:US
Practice Address - Phone:870-246-8623
Practice Address - Fax:870-246-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C764OtherARKANSAS BCBS
AR141082742Medicaid
AR5C764OtherARKANSAS BCBS
AR=========30OtherQUALCHOICE