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General NPI Number Information
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NPI Number | 1750085189
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Entity Type | Organization
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Legal Business Name | ADVANCED SPINE & THERAPY, LLC
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 300 CRESTWOOD CIR
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City | MENA
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State | AR
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Zip | 71953-5515
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Country | US
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Telephone | 479-216-2315
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Fax | 479-413-8090
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Provider Business Mailing Address
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Address Line | 300 CRESTWOOD CIR
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City | MENA
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State | AR
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Zip | 71953-5515
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Country | US
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Telephone | 479-216-2315
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Fax | 479-413-8090
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. DELTA GUNN
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Credential |
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Telephone | 479-216-2315
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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 |
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License Number State |
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