Healthcare Provider Details

I. General information

NPI: 1235856436
Provider Name (Legal Business Name): ADAPTIVE TEAM THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N TYLER ST
LITTLE ROCK AR
72205-1749
US

IV. Provider business mailing address

3722 GRACEFUL OAKS DR
BENTON AR
72019-2028
US

V. Phone/Fax

Practice location:
  • Phone: 501-413-9546
  • Fax: 501-325-1315
Mailing address:
  • Phone: 501-413-9546
  • Fax: 501-325-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL GLENN
Title or Position: SOLE MEMBER
Credential: MS OTR/L
Phone: 501-413-9546