Healthcare Provider Details

I. General information

NPI: 1881848380
Provider Name (Legal Business Name): SPORTS THERAPY OF LITTLE ROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 VIEWPOINTE COVE
LITTLE ROCK AR
72223
US

IV. Provider business mailing address

10 VIEWPOINTE COVE
LITTLE ROCK AR
72223
US

V. Phone/Fax

Practice location:
  • Phone: 877-932-7331
  • Fax:
Mailing address:
  • Phone: 877-932-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA LANDERS
Title or Position: CLINIC MANAGER
Credential: DPT
Phone: 877-932-7331