Healthcare Provider Details

I. General information

NPI: 1700918471
Provider Name (Legal Business Name): PHYSICAL THERAPY CONNECTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 HIGHWAY 62 E
MOUNTAIN HOME AR
72653-3215
US

IV. Provider business mailing address

PO BOX 587
MOUNTAIN HOME AR
72654-0587
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-4550
  • Fax: 870-424-4558
Mailing address:
  • Phone: 870-424-4550
  • Fax: 870-424-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT1978
License Number StateAR

VIII. Authorized Official

Name: MRS. JULIE RENEE KELLY
Title or Position: OFFICE MANAGER
Credential: C.P.C.
Phone: 870-424-4550