Healthcare Provider Details

I. General information

NPI: 1558531061
Provider Name (Legal Business Name): MATTHEWS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 INGRAM ST SUITE B
CLINTON AR
72031-6889
US

IV. Provider business mailing address

119 INGRAM ST SUITE B
CLINTON AR
72031-6889
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-8881
  • Fax: 501-745-3113
Mailing address:
  • Phone: 501-745-8881
  • Fax: 501-745-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. WENDY B MATTHEWS
Title or Position: OWNER/OFFICE MANAGER
Credential:
Phone: 501-745-8881