Healthcare Provider Details

I. General information

NPI: 1205937745
Provider Name (Legal Business Name): JACKSONVILLE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 JOHN HARDEN DR
JACKSONVILLE AR
72076-3775
US

IV. Provider business mailing address

208 JOHN HARDEN DR
JACKSONVILLE AR
72076-3775
US

V. Phone/Fax

Practice location:
  • Phone: 501-982-9511
  • Fax: 501-982-9512
Mailing address:
  • Phone: 501-982-9511
  • Fax: 501-982-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number727
License Number StateAR

VIII. Authorized Official

Name: PROF. HARRY MORTON
Title or Position: PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 501-982-9511