Healthcare Provider Details

I. General information

NPI: 1720912579
Provider Name (Legal Business Name): SKILLED THERAPY PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 COUNTS MASSIE RD STE A
MAUMELLE AR
72113-6720
US

IV. Provider business mailing address

8030 COUNTS MASSIE RD STE A
MAUMELLE AR
72113-6720
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6013
  • Fax: 501-358-6013
Mailing address:
  • Phone: 501-358-6013
  • Fax: 501-358-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACKIE M BRACEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-358-6013