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General NPI Number Information
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NPI Number | 1811081268
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Entity Type | Organization
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Legal Business Name | MCBRIDE REHABILITATION GROUP LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 978 COLEY DRIVE
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653
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Country | US
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Telephone | 870-425-5881
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Fax | 870-425-5966
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Provider Business Mailing Address
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Address Line | PO BOX 1507
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-1507
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Country | US
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Telephone | 870-425-5881
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Fax | 870-425-5966
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Authorized Official
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Title or Position | OWNER
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Name | MR. BLAKE MCBRIDE
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Credential | PT
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Telephone | 870-425-5881
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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 | PT1458
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License Number State | AR
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