Healthcare Provider Details

I. General information

NPI: 1295882843
Provider Name (Legal Business Name): SOUTH ARKANSAS REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD WARREN ROAD
MONTICELLO AR
71655
US

IV. Provider business mailing address

1200 OLD WARREN ROAD
MONTICELLO AR
71655
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-1548
  • Fax: 870-367-1383
Mailing address:
  • Phone: 870-367-1548
  • Fax: 870-367-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN NATHANIEL GRUBBS
Title or Position: OWNER
Credential: PT
Phone: 870-367-1548