Healthcare Provider Details

I. General information

NPI: 1679171383
Provider Name (Legal Business Name): ABOVE AND BEYOND MOBILE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SPRIGGS RD
NORTH LITTLE ROCK AR
72118-2336
US

IV. Provider business mailing address

510 SPRIGGS RD
NORTH LITTLE ROCK AR
72118-2336
US

V. Phone/Fax

Practice location:
  • Phone: 501-733-1483
  • Fax:
Mailing address:
  • Phone: 501-733-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL RENEE EUBANKS
Title or Position: OWNER
Credential: OTR
Phone: 501-733-1483