Healthcare Provider Details

I. General information

NPI: 1285678052
Provider Name (Legal Business Name): GRAND PRAIRIE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W 7TH ST
DE WITT AR
72042-3279
US

IV. Provider business mailing address

317 W 7TH ST
DE WITT AR
72042-3279
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-8400
  • Fax: 870-946-8511
Mailing address:
  • Phone: 870-946-8400
  • Fax: 870-946-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT1005
License Number StateAR

VIII. Authorized Official

Name: MRS. JERRIE ANN CUMMINGS
Title or Position: CO-OWNER
Credential: P.T.
Phone: 870-946-8400