Healthcare Provider Details

I. General information

NPI: 1174966469
Provider Name (Legal Business Name): PEDIATRIC THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 LAYMAN DR
JONESBORO AR
72404-9143
US

IV. Provider business mailing address

1217 LAYMAN DR
JONESBORO AR
72404-9143
US

V. Phone/Fax

Practice location:
  • Phone: 870-636-7571
  • Fax: 870-934-1270
Mailing address:
  • Phone: 870-636-7571
  • Fax: 870-934-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2766
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2366
License Number StateAR

VIII. Authorized Official

Name: CHAMBLEE WITHERSPOON
Title or Position: OWNER
Credential: PT
Phone: 870-636-7571