MEDICARE: MOUNTAINCREST REHAB OF BELLA VISTA, 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
2	225100000X	Physical Therapist	PT1741	AR
3	225100000X	Physical Therapist	PT2105	AR
4	225100000X	Physical Therapist	PT2113	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	5F289	OTHER	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932165982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINCREST REHAB OF BELLA VISTA, INC.

Provider Business Mailing Address
First Line	:	1801 FOREST HILLS BLVD.
Second Line	:	STE #205
City	:	BELLA VISTA
State	:	AR
Zip	:	72715
Country	:	US
Telephone Number	:	479-855-9348
Fax Number	:	479-855-9358

Provider Business Practice Location Address
First Line	:	1801 FOREST HILLS BLVD
Second Line	:	STE #205
City	:	BELLA VISTA
State	:	AR
Zip	:	72715
Country	:	US
Telephone Number	:	479-855-9348
Fax Number	:	479-855-9358

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEWART T ONG
Credential	:	PT
Telephone Number	:	479-855-9348

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	04/25/2011

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