Healthcare Provider Details

I. General information

NPI: 1467437087
Provider Name (Legal Business Name): MOUNTAINCREST REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 N MAIN ST
HARRISON AR
72601-2915
US

IV. Provider business mailing address

PO BOX 841
HARRISON AR
72602-0841
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-5573
  • Fax: 870-743-5974
Mailing address:
  • Phone: 870-743-5573
  • Fax: 870-743-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOEL DAMARILLO SEBAG
Title or Position: EXECUTIVE DIRECTOR
Credential: RPT
Phone: 870-743-5573