Healthcare Provider Details

I. General information

NPI: 1093848095
Provider Name (Legal Business Name): PEDIATRIC THERAPY SERVICES OF LITTLE ROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11517 KANIS RD
LITTLE ROCK AR
72211-3724
US

IV. Provider business mailing address

2 CHATEL DR
LITTLE ROCK AR
72223-9113
US

V. Phone/Fax

Practice location:
  • Phone: 501-993-8707
  • Fax: 501-223-8075
Mailing address:
  • Phone: 501-993-7171
  • Fax: 501-223-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEE ANN BROSH
Title or Position: OWNER
Credential: M.A, CCC-SLP
Phone: 501-993-7171