Healthcare Provider Details

I. General information

NPI: 1225670250
Provider Name (Legal Business Name): SPECIALIZED PHYSICAL THERAPY OF NWA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 W PAULINE WHITAKER PKWY STE 120
ROGERS AR
72758-7341
US

IV. Provider business mailing address

3405 S 117TH ST
OMAHA NE
68144-4642
US

V. Phone/Fax

Practice location:
  • Phone: 479-202-0337
  • Fax: 479-202-0338
Mailing address:
  • Phone: 402-981-1406
  • Fax: 866-304-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELYN B ZIMMERMAN
Title or Position: OWNER/MEMBER
Credential: PT
Phone: 402-981-1406