Healthcare Provider Details

I. General information

NPI: 1518282391
Provider Name (Legal Business Name): PTWORKS,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 GREEN MEADOW LN APT D
HOLIDAY ISLAND AR
72631-4651
US

IV. Provider business mailing address

PO BOX 3204
HOLIDAY ISLAND AR
72631-3204
US

V. Phone/Fax

Practice location:
  • Phone: 479-244-7208
  • Fax:
Mailing address:
  • Phone: 479-244-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1385
License Number StateAR

VIII. Authorized Official

Name: MR. WILLIAM SCOTT JOHNSON
Title or Position: OWNER
Credential: P.T.
Phone: 479-244-7208