MEDICARE: MAUMELLE PHYSICAL THERAPY

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	PT2475	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
2	5F332	OTHER	AR	AR BCBS

General Provider Information

NPI Number	:	1730163072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAUMELLE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 13567
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-0567
Country	:	US
Telephone Number	:	501-753-2201
Fax Number	:	501-753-2207

Provider Business Practice Location Address
First Line	:	9843 MAUMELLE BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-7027
Country	:	US
Telephone Number	:	501-851-6600
Fax Number	:	501-851-6643

Authorized Official
Title or Position	:	OWNER
Name	:	KENNY A DE LUCA
Credential	:	P.T.
Telephone Number	:	501-753-2201

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	02/17/2010

Similar Medicare Providers

1114901451 — KENNY A DE LUCA P.T.
Practice Location Address:

9843 MAUMELLE BLVD
NORTH LITTLE ROCK, AR
72113-7027

Practice Phone: 501-753-2201
Practice Fax: 501-753-2207

1689017212 — THE MANOR
Practice Location Address:

9800 MAUMELLE BLVD
NORTH LITTLE ROCK, AR
72113-7027

Practice Phone: 501-444-2390
Practice Fax: 501-421-9140

1194430561 — MARY ELIZABETH COX APRN,FNP-C
Practice Location Address:

9821 MAUMELLE BLVD
NORTH LITTLE ROCK, AR
72113-7027

Practice Phone: 501-779-3559
Practice Fax:

1285334300 — JOANNA PATRICE GREEN
Practice Location Address:

12320 INTERSTATE 30
LITTLE ROCK, AR
72210-7027

Practice Phone: 501-410-1567
Practice Fax:

1306546429 — MELLISSA WOLF
Practice Location Address:

12320 INTERSTATE 30
LITTLE ROCK, AR
72210-7027

Practice Phone: 501-410-1567
Practice Fax:

1942900063 — ELLEN DAWN SULLIVAN
Practice Location Address:

12320 INTERSTATE 30
LITTLE ROCK, AR
72210-7027

Practice Phone: 501-658-6010
Practice Fax:

Directions to “MAUMELLE PHYSICAL THERAPY ” 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 © 2007-2025 (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.