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General NPI Number Information
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NPI Number | 1023054145
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Entity Type | Organization
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Legal Business Name | NORTHSIDE THERAPY CENTER INC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4216 E MCCAIN BLVD
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117
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Country | US
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Telephone | 501-687-0328
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Fax | 501-687-0330
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Provider Business Mailing Address
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Address Line | 4216 E MCCAIN BLVD
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117
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Country | US
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Telephone | 501-687-0328
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Fax | 501-687-0330
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MR. STANLEY JENKINS HARRIS
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Credential | PT, DPT
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Telephone | 501-687-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 0000001458
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License Number State | AR
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