MEDICARE: PHYSICAL THERAPY ADVANTAGE, 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	302F00000X	Exclusive Provider Organization	1240	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1225144793	OTHER	AR	KELLEY GLENN

General Provider Information

NPI Number	:	1184982894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY ADVANTAGE, LLC

Provider Business Mailing Address
First Line	:	52 DUCLAIR CT
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-9570
Country	:	US
Telephone Number	:	501-519-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 DUCLAIR CT
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-9570
Country	:	US
Telephone Number	:	501-519-0144
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. KELLEY GLENN
Credential	:	DPT
Telephone Number	:	501-519-0144

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/01/2012

Similar Medicare Providers

1487790358 — LUCAS MESDAG DMD
Practice Location Address:

1807 COLUMBIA COVE LN S
ROCK ISLAND, WA
98850-9570

Practice Phone: 509-293-2015
Practice Fax:

1952937344 — RONALD WALTER HERTWIG JR.
Practice Location Address:

114 BROADMOOR DR
FLAT ROCK, NC
28731-9570

Practice Phone: 770-330-0239
Practice Fax:

1851395792 — GASTROENTEROLOGY ASSOCIATES PA
Practice Location Address:

11700 CANTRELL RD
LITTLE ROCK, AR
72223-1705

Practice Phone: 501-664-6980
Practice Fax: 501-664-4738

1295732758 — KEITH D HOUGH M.D.
Practice Location Address:

14309 CANTRELL RD , SUITE 7
LITTLE ROCK, AR
72223-4217

Practice Phone: 501-224-6727
Practice Fax: 501-224-0374

1386641520 — SUNDER KRISHNAN MD
Practice Location Address:

14918 CANTRELL RD
LITTLE ROCK, AR
72223-4248

Practice Phone: 501-975-5005
Practice Fax: 501-975-5008

1609873983 — BENNY J GREEN M.D.
Practice Location Address:

14309 CANTRELL RD
LITTLE ROCK, AR
72223-4230

Practice Phone: 501-224-6727
Practice Fax: 501-224-0374

Directions to “PHYSICAL THERAPY ADVANTAGE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.