Healthcare Provider Details

I. General information

NPI: 1346077526
Provider Name (Legal Business Name): PTRIAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S 2ND ST STE C
ROGERS AR
72756-4511
US

IV. Provider business mailing address

11993 W AIRPORT DR
GARFIELD AR
72732-9529
US

V. Phone/Fax

Practice location:
  • Phone: 479-925-9300
  • Fax:
Mailing address:
  • Phone: 479-925-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SALLY J GLADDEN
Title or Position: OWNER
Credential: DPT
Phone: 479-276-3458