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General NPI Number Information
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NPI Number | 1295197135
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Entity Type | Organization
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Legal Business Name | INFINITY THERAPY, LLC
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Dates
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Enumeration Date | 03/21/2016
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 7327 WORTH AVE E
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City | BENTON
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State | AR
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Zip | 72019
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Country | US
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Telephone | 501-773-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 7327 WORTH AVENUE EAST
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City | BENTON
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State | AR
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Zip | 72019
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Country | UM
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Telephone | 501-773-7155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PORTIA SIMONE CARR
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Credential | MS,CCC-SLP
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Telephone | 501-773-7155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 927660614
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License Number State | AR
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