Healthcare Provider Details

I. General information

NPI: 1265871248
Provider Name (Legal Business Name): KIDSPIRATION PEDIATRIC THERAPY SERVICES TOO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2013
Last Update Date: 06/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 EAST MAIN ST
MELBOURNE AR
72556
US

IV. Provider business mailing address

PO BOX 2533
MOUNTAIN HOME AR
72654-2533
US

V. Phone/Fax

Practice location:
  • Phone: 870-368-4586
  • Fax: 870-368-4587
Mailing address:
  • Phone: 870-368-4586
  • Fax: 870-368-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGAN THARP
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-710-1336