Healthcare Provider Details

I. General information

NPI: 1447637657
Provider Name (Legal Business Name): TTJ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MENA ST
MENA AR
71953-3339
US

IV. Provider business mailing address

605 MENA ST
MENA AR
71953-3339
US

V. Phone/Fax

Practice location:
  • Phone: 479-385-1236
  • Fax:
Mailing address:
  • Phone: 479-385-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RYAN A WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 479-385-1236