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General NPI Number Information
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NPI Number | 1396431920
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Entity Type | Organization
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Legal Business Name | SIDEWALK THERAPY GROUP, LLC
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 2200 KAVANAUGH BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3936
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Country | US
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Telephone | 501-251-7864
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Fax |
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Provider Business Mailing Address
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Address Line | 1624 N POLK ST
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLI REYES
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Credential | DPT
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Telephone | 501-251-7864
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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