Healthcare Provider Details

I. General information

NPI: 1245491224
Provider Name (Legal Business Name): THE THERAPY SPOT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2008
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 MARKET ST.
FAYETTEVILLE AR
72703-7519
US

IV. Provider business mailing address

3130 N MARKET AVE
FAYETTEVILLE AR
72703-3516
US

V. Phone/Fax

Practice location:
  • Phone: 479-595-0599
  • Fax:
Mailing address:
  • Phone: 479-595-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#1880
License Number StateAR

VIII. Authorized Official

Name: MRS. TERESA GAYLE BECK-FULLER
Title or Position: CO-OWNER
Credential: M.S., CCC-SLP
Phone: 479-531-7727