MEDICARE: PHYSICIAN'S THERAPY GROUP, 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
1	225100000X	Physical Therapist
2	2251P0200X	Pediatric Physical Therapist
3	225200000X	Physical Therapy Assistant
4	225X00000X	Occupational Therapist
5	225XP0200X	Pediatric Occupational Therapist
6	2355S0801X	Speech-Language Assistant
7	222Q00000X	Developmental Therapist
8	235Z00000X	Speech-Language Pathologist	SLP 139	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144276585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN'S THERAPY GROUP, LLC

Provider Business Mailing Address
First Line	:	3291 S THOMPSON ST STE F101
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-7342
Country	:	US
Telephone Number	:	479-750-3535
Fax Number	:	479-750-3539

Provider Business Practice Location Address
First Line	:	3291 S THOMPSON ST STE F101
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-7342
Country	:	US
Telephone Number	:	479-750-3535
Fax Number	:	479-750-3539

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MATT MONTGOMERY
Credential	:
Telephone Number	:	479-750-3535

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/14/2022

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Directions to “PHYSICIAN'S THERAPY GROUP, LLC ” Practice Location

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