| NPI | 1902224512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MICHELLE DUNCAN Credentialing Specialist 479-967-2322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Additional Taxonomies | 251C00000X |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: AR PTA2755) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-12-28 |