MEDICARE: PINNACLE HOME 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

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	:	1740213859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE HOME THERAPY

Provider Business Mailing Address
First Line	:	5912 CYPRESS CREEK DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6355
Country	:	US
Telephone Number	:	501-771-2005
Fax Number	:	501-771-2005

Provider Business Practice Location Address
First Line	:	5912 CYPRESS CREEK DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6355
Country	:	US
Telephone Number	:	501-771-2005
Fax Number	:	501-771-2005

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER CAVNOR
Credential	:	MS.PT
Telephone Number	:	501-771-2005

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	12/04/2009

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Directions to “PINNACLE HOME THERAPY ” Practice Location

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