Healthcare Provider Details

I. General information

NPI: 1639860208
Provider Name (Legal Business Name): AMIGOS PEDIATRIC THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 JFK BLVD STE C
NORTH LITTLE ROCK AR
72116-8264
US

IV. Provider business mailing address

4131 JFK BLVD STE C
NORTH LITTLE ROCK AR
72116-8264
US

V. Phone/Fax

Practice location:
  • Phone: 501-502-5420
  • Fax: 501-557-3657
Mailing address:
  • Phone: 501-502-5420
  • Fax: 501-557-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY VILLARREAL FLEEMAN
Title or Position: PRESIDENT
Credential: MS CCC-SLP
Phone: 501-502-5420