Healthcare Provider Details

I. General information

NPI: 1346336245
Provider Name (Legal Business Name): TRI-LAKES PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CARPENTER DAM ROAD BLDG. L
HOT SPRINGS AR
71901-8218
US

IV. Provider business mailing address

307 CARPENTER DAM RD BLDG. L
HOT SPRINGS AR
71901-8218
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-6353
  • Fax: 501-321-4783
Mailing address:
  • Phone: 501-623-6353
  • Fax: 501-321-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 1481
License Number StateAR

VIII. Authorized Official

Name: MR. JON T HARDY
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: M.P.T.
Phone: 501-623-6353