Healthcare Provider Details

I. General information

NPI: 1275514838
Provider Name (Legal Business Name): GLENWOOD PHYSICAL THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 HIGHWAY 70 E SUITE D
GLENWOOD AR
71943-8801
US

IV. Provider business mailing address

253 HIGHWAY 70 E SUITE D
GLENWOOD AR
71943-8801
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-6044
  • Fax: 870-356-6045
Mailing address:
  • Phone: 870-356-6044
  • Fax: 870-356-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TODD WILSON GEORGE
Title or Position: PRESIDENT
Credential: M.P.T.
Phone: 870-356-6044