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General NPI Number Information
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NPI Number | 1699959577
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Entity Type | Organization
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Legal Business Name | ARKANSAS SPORTS PERFORMANCE CENTER
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 4215 S SHACKLEFORD RD STE 4D
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City | LITTLE ROCK
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State | AR
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Zip | 72204-7115
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Country | US
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Telephone | 501-539-3278
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 S SHACKLEFORD RD STE 4D
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City | LITTLE ROCK
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State | AR
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Zip | 72204-7115
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Country | US
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Telephone | 501-539-3278
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM H MAACK
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Credential | ATC, CSCS
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Telephone | 501-539-3278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2870
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License Number State | AR
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