Healthcare Provider Details

I. General information

NPI: 1487615779
Provider Name (Legal Business Name): MAUMELLE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 COLLEGE AVE
CONWAY AR
72034
US

IV. Provider business mailing address

3605 COLLEGE AVE
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-2235
  • Fax: 501-327-1601
Mailing address:
  • Phone: 501-327-2235
  • Fax: 501-327-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. TASI E WYATT
Title or Position: OWNER
Credential:
Phone: 501-327-2235