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NPI Code Detail

MEDICARE: PEDIATRICS PLUS THERAPY SERVICES, LLC

MEDICARE: PEDIATRICS PLUS THERAPY SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0700XHearing and Speech Clinic/Center
2261QP2000XPhysical Therapy Clinic/Center
3261QD1600XDevelopmental Disabilities Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25C381OTHERARBLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number : 1134277320
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRICS PLUS THERAPY SERVICES, LLC
Provider Business Mailing Address
First Line : 1000 SWN DRIVE
Second Line : SUITE 101
City : CONWAY
State : AR
Zip : 72032-7836
Country : US
Telephone Number : 501-328-3274
Fax Number :
Provider Business Practice Location Address
First Line : 2740 COLLEGE AVE
Second Line :
City : CONWAY
State : AR
Zip : 72034-6141
Country : US
Telephone Number : 501-329-5459
Fax Number : 501-327-1738
Authorized Official
Title or Position : OWNER
Name : MRS. AMANDA DENTON
Credential : MSPT
Telephone Number : 501-329-5459
Provider Enumeration Date : 01/06/2007
Last Update Date : 07/17/2025

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