Healthcare Provider Details

I. General information

NPI: 1720419930
Provider Name (Legal Business Name): GATES THERAPY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 W CHESTNUT ST
ROGERS AR
72756-0351
US

IV. Provider business mailing address

3625 W CHESTNUT ST
ROGERS AR
72756-0351
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-0101
  • Fax: 476-246-0606
Mailing address:
  • Phone: 479-246-0101
  • Fax: 479-246-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT2931
License Number StateAR

VIII. Authorized Official

Name: SARA GATES
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 501-317-7994