Healthcare Provider Details

I. General information

NPI: 1437294766
Provider Name (Legal Business Name): PENDERGRASS THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W MAIN ST
CORNING AR
72422-1903
US

IV. Provider business mailing address

1700 W MAIN ST P.O. BOX 511
CORNING AR
72422-1903
US

V. Phone/Fax

Practice location:
  • Phone: 870-857-0049
  • Fax: 870-857-3027
Mailing address:
  • Phone: 870-857-0049
  • Fax: 870-857-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BARBARA L TRIBBLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-857-0049