Healthcare Provider Details

I. General information

NPI: 1467892406
Provider Name (Legal Business Name): HEAD TO TOE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 PEYTON ST
WARD AR
72176-8563
US

IV. Provider business mailing address

6929 JFK BLVD # 20-287
NORTH LITTLE ROCK AR
72116-5312
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-2949
  • Fax: 501-941-2952
Mailing address:
  • Phone: 501-941-2949
  • Fax: 501-941-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG01445
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberMG01445
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberMG01445
License Number StateAR

VIII. Authorized Official

Name: ROBERT CARY YARBROUGH
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 501-590-0439