Healthcare Provider Details

I. General information

NPI: 1114161015
Provider Name (Legal Business Name): NEURORTHO REHAB SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 W 28TH AVE
PINE BLUFF AR
71603-5054
US

IV. Provider business mailing address

PO BOX 1750
PINE BLUFF AR
71613-1750
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-0543
  • Fax: 870-534-0541
Mailing address:
  • Phone: 870-534-0543
  • Fax: 870-534-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT1522
License Number StateAR

VIII. Authorized Official

Name: MR. REGIN JOHN REGINIO
Title or Position: PRESIDENT
Credential: P.T.
Phone: 870-534-0543