=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407809080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SRL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11121 N RODNEY PARHAM RD STE 2A
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72212-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-225-0111
-----------------------------------------------------
Fax | 501-613-0886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11121 N RODNEY PARHAM RD STE 2A
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72212-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-225-0111
-----------------------------------------------------
Fax | 501-613-0886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST/ADMINISTRA
-----------------------------------------------------
Name | SUSAN LOUKS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 501-225-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------