=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013008838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL GOD'S CHILDREN THERAPY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 N 1ST ST STE 4
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72076-4139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-241-0410
-----------------------------------------------------
Fax | 501-241-0125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 N 1ST ST STE 4
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72076-4139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-241-0410
-----------------------------------------------------
Fax | 501-241-0125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | MRS. MARCIA JANE SHEPHERD
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 501-241-0410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OTR1657
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP#2013
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | PT 2238
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------