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General NPI Number Information
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NPI Number | 1851807424
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Entity Type | Organization
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Legal Business Name | TIARKS THERAPY SERVICES
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 2104 S WALTON BLVD
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City | BENTONVILLE
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State | AR
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Zip | 72712-6732
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Country | US
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Telephone | 479-619-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 1551 N LEXINGTON DR
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City | CENTERTON
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State | AR
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Zip | 72719-9539
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Country | US
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Telephone | 479-619-5514
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | TRISTAN N TIARKS
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Credential | DPT
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Telephone | 479-619-5514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT3288
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License Number State | AR
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