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General NPI Number Information
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NPI Number | 1467482265
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Entity Type | Organization
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Legal Business Name | CENTRAL ARKANSAS SPORTS MEDICINE
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 2400 CRESTWOOD SUITE 107
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7665
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Country | US
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Telephone | 501-758-1300
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Fax | 501-758-1316
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Provider Business Mailing Address
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Address Line | 2400 CRESTWOOD SUITE 107
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7665
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Country | US
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Telephone | 501-758-1300
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Fax | 501-758-1316
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN RENHSAW
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Credential | MSPT, ATC
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Telephone | 501-758-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2221
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License Number State | AR
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