Healthcare Provider Details

I. General information

NPI: 1699987511
Provider Name (Legal Business Name): STEVEN WAYNE FORBUSH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DONAGHEY AVE PHYSICAL THERAPY BUILDING
CONWAY AR
72035-5003
US

IV. Provider business mailing address

1530 CHINOOK
CONWAY AR
72034-8473
US

V. Phone/Fax

Practice location:
  • Phone: 501-450-5554
  • Fax: 501-450-5822
Mailing address:
  • Phone: 501-450-5554
  • Fax: 501-450-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2879
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: