Healthcare Provider Details

I. General information

NPI: 1326008863
Provider Name (Legal Business Name): CHILDREN'S THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 E JOYCE BLVD SUITE 2
FAYETTEVILLE AR
72703-4519
US

IV. Provider business mailing address

2474 E JOYCE BLVD SUITE 2
FAYETTEVILLE AR
72703-4519
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8326
  • Fax: 479-521-5439
Mailing address:
  • Phone: 479-521-8326
  • Fax: 479-521-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 2309
License Number StateAR

VIII. Authorized Official

Name: MRS. KYMBRLY L. HANNAH
Title or Position: REGISTERED PHYSICAL THERAPIST
Credential: R.P.T.
Phone: 479-530-5791