Healthcare Provider Details

I. General information

NPI: 1467901132
Provider Name (Legal Business Name): MEREDITH ROSE GRUBBS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 AIRPORT ROAD
HOT SPRINGS AR
71913
US

IV. Provider business mailing address

1310 WEST MAIN STREET SUITE 201
RUSSELLVILLE AR
72801
US

V. Phone/Fax

Practice location:
  • Phone: 501-767-2710
  • Fax:
Mailing address:
  • Phone: 479-968-2001
  • Fax: 479-964-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: