Healthcare Provider Details

I. General information

NPI: 1720387145
Provider Name (Legal Business Name): GAYLA LIKE PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SFC 1003
COLT AR
72326-8516
US

IV. Provider business mailing address

311 SFC 1003
COLT AR
72326-8516
US

V. Phone/Fax

Practice location:
  • Phone: 870-633-4443
  • Fax: 870-633-0647
Mailing address:
  • Phone: 870-633-4443
  • Fax: 870-633-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2967
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#2616
License Number StateAR

VIII. Authorized Official

Name: MRS. GAYLA DEANNA LIKE
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 870-633-4443