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General NPI Number Information
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NPI Number | 1174966469
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY SOLUTIONS LLC
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 1217 LAYMAN DR
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City | JONESBORO
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State | AR
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Zip | 72404-9143
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Country | US
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Telephone | 870-636-7571
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Fax | 870-934-1270
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Provider Business Mailing Address
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Address Line | 1217 LAYMAN DR
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City | JONESBORO
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State | AR
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Zip | 72404-9143
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Country | US
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Telephone | 870-636-7571
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Fax | 870-934-1270
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Authorized Official
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Title or Position | OWNER
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Name | CHAMBLEE WITHERSPOON
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Credential | PT
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Telephone | 870-636-7571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR2366
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2766
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License Number State | AR
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