MEDICARE: APTC OF NORTH LITTLE ROCK, INC

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	0000000192	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00855769	OTHER	AR	RAILROAD MEDICARE
3	DA7015	OTHER	AR	RAILROAD MEDICARE GROUP
5	P00855756	OTHER	AR	RAILROAD MEDICARE
7	5F776	OTHER	AR	MEDICARE NUMBER
8	DN8325	OTHER	AR	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4657970	OTHER	AR	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	374964900	OTHER	AR	OWCP: OFFICE OF WORK COMP

General Provider Information

NPI Number	:	1346245842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APTC OF NORTH LITTLE ROCK, INC

Provider Business Mailing Address
First Line	:	4540 JOHN F KENNEDY BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7309
Country	:	US
Telephone Number	:	501-758-5555
Fax Number	:	501-758-5941

Provider Business Practice Location Address
First Line	:	4540 JOHN F KENNEDY BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7309
Country	:	US
Telephone Number	:	501-758-5555
Fax Number	:	501-758-5941

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELISSA HOLLAND
Credential	:
Telephone Number	:	501-224-5454

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/07/2021

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Directions to “APTC OF NORTH LITTLE ROCK, INC ” Practice Location

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