Healthcare Provider Details

I. General information

NPI: 1902304876
Provider Name (Legal Business Name): NORTHWEST ARKANSAS PHYSICAL ABILITY TESTING CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WAGON WHEEL ROAD
SPRINGDALE AR
72762
US

IV. Provider business mailing address

P.O. BOX 921
LOWELL AR
72745
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-3072
  • Fax: 479-725-3098
Mailing address:
  • Phone: 479-725-3072
  • Fax: 479-725-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT1914
License Number StateAR

VIII. Authorized Official

Name: JONATHAN WADE LEE
Title or Position: OWNER/THERAPIST
Credential: PT
Phone: 479-725-3072