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General NPI Number Information
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NPI Number | 1659437945
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Entity Type | Organization
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Legal Business Name | MILLENNIUM REHAB OF ARKANSAS LLC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 810 JOE BROOKS DR
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City | JONESBORO
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State | AR
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Zip | 72401-4133
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Country | US
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Telephone | 870-931-6789
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Fax | 870-931-4363
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Provider Business Mailing Address
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Address Line | 810 JOE BROOKS DR
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City | JONESBORO
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State | AR
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Zip | 72401-4133
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Country | US
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Telephone | 870-931-6789
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Fax | 870-931-4363
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Authorized Official
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Title or Position | MEMBER
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Name | MR. SY NIKSEFAT
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Credential |
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Telephone | 870-931-6789
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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 | 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 #4
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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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