Healthcare Provider Details

I. General information

NPI: 1154568939
Provider Name (Legal Business Name): ARKANSAS KIDS THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WYATT CV
HOT SPRINGS AR
71913-1860
US

IV. Provider business mailing address

150 WYATT CV
HOT SPRINGS AR
71913-1860
US

V. Phone/Fax

Practice location:
  • Phone: 501-538-8300
  • Fax:
Mailing address:
  • Phone: 501-538-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TROUPE BRYANT
Title or Position: CEO
Credential:
Phone: 501-538-8300