MEDICARE: 3D PT, 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	2399	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5F225	OTHER	AR	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1730109661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3D PT, INC

Provider Business Mailing Address
First Line	:	2021 E MAIN ST
Second Line	:	B
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-5504
Country	:	US
Telephone Number	:	479-524-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E MAIN ST
Second Line	:	B
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-5504
Country	:	US
Telephone Number	:	479-524-3378
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NOEL C. TUGWELL
Credential	:	MPT, MS
Telephone Number	:	479-524-3378

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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