Healthcare Provider Details

I. General information

NPI: 1598312381
Provider Name (Legal Business Name): OPTIMAL THERAPY OF NWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 W SOUTHERN HILLS BLVD STE 6
ROGERS AR
72758-8231
US

IV. Provider business mailing address

11442 BRUBAKER RD
WEST FORK AR
72774-9245
US

V. Phone/Fax

Practice location:
  • Phone: 501-231-3821
  • Fax:
Mailing address:
  • Phone: 501-231-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN KENT
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: PT, DPT
Phone: 501-231-3821