Healthcare Provider Details

I. General information

NPI: 1730188350
Provider Name (Legal Business Name): SHERIDAN PHYSICAL THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OPPORTUNITY DR
SHERIDAN AR
72150-9185
US

IV. Provider business mailing address

15 OPPORTUNITY DR
SHERIDAN AR
72150-9185
US

V. Phone/Fax

Practice location:
  • Phone: 870-942-8335
  • Fax: 870-942-2234
Mailing address:
  • Phone: 870-942-8335
  • Fax: 870-942-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT860
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT860
License Number StateAR

VIII. Authorized Official

Name: MR. ROGER W SAENGER
Title or Position: DIRECTOR AND OWNER
Credential: RPT
Phone: 870-942-8335