Healthcare Provider Details

I. General information

NPI: 1083068290
Provider Name (Legal Business Name): TRILOGY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 MARKET ST SUITE 7
DOVER AR
72837-9110
US

IV. Provider business mailing address

8952 MARKET ST SUITE 7
DOVER AR
72837-9110
US

V. Phone/Fax

Practice location:
  • Phone: 501-860-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 1789
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR506
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP 263
License Number StateAR

VIII. Authorized Official

Name: SANDRA WYATT
Title or Position: OWNER/MEMBER
Credential:
Phone: 501-860-3500