Healthcare Provider Details

I. General information

NPI: 1215098462
Provider Name (Legal Business Name): WESTERN ARKANSAS PEDIATRIC REHAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 CHARMONT DRIVE
CHARLESTON AR
72933-0871
US

IV. Provider business mailing address

PO BOX 871
CHARLESTON AR
72933-0871
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-6752
  • Fax:
Mailing address:
  • Phone: 479-965-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNA MARIE ROWLAND
Title or Position: PRESIDENT
Credential: OTR
Phone: 479-965-2612