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General NPI Number Information
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NPI Number | 1245431964
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Entity Type | Organization
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Legal Business Name | KINGS RIVER PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 402 W COLLEGE AVE.
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City | BERRYVILLE
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State | AR
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Zip | 72616-3142
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Country | US
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Telephone | 870-423-3316
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Fax | 870-423-3177
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Provider Business Mailing Address
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Address Line | 402 W COLLEGE AVE.
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City | BERRYVILLE
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State | AR
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Zip | 72616-3142
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Country | US
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Telephone | 870-423-3316
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Fax | 870-423-3177
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY WADE HILL
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Credential | RPT
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Telephone | 870-423-3316
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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 | PT2047
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License Number State | AR
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