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General NPI Number Information
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NPI Number | 1013407741
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Entity Type | Organization
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Legal Business Name | THE CENTER HEALTH & WELLNESS
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 3801 JFK BLVD STE C
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-8247
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Country | US
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Telephone | 501-712-4333
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Fax | 501-712-4333
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Provider Business Mailing Address
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Address Line | 3801 JFK BLVD STE C
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-8247
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Country | US
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Telephone | 501-712-4333
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Fax | 501-712-4333
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | DR. CRYSTAL LACKEY
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Credential | PT, DPT
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Telephone | 501-712-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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