Healthcare Provider Details

I. General information

NPI: 1841324209
Provider Name (Legal Business Name): MCBRYDE THERAPY OPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HIGHWAY 62 412 SUITE A
ASH FLAT AR
72513-9594
US

IV. Provider business mailing address

75 HIGHWAY 62 412 SUITE A
ASH FLAT AR
72513-9594
US

V. Phone/Fax

Practice location:
  • Phone: 870-994-7778
  • Fax: 870-994-2531
Mailing address:
  • Phone: 870-994-7778
  • Fax: 870-994-2531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ALICIA D. MCBRYDE
Title or Position: OWNER
Credential:
Phone: 870-994-7778